Provider Demographics
NPI:1629771456
Name:GRENNAN, MOLLY (BFA, RBT)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:
Last Name:GRENNAN
Suffix:
Gender:F
Credentials:BFA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5730
Mailing Address - Country:US
Mailing Address - Phone:516-590-7575
Mailing Address - Fax:
Practice Address - Street 1:88 WALDRON AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-3407
Practice Address - Country:US
Practice Address - Phone:845-323-0853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22-244569106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician