Provider Demographics
NPI:1679524664
Name:MOLSON, JULIA A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:A
Last Name:MOLSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 SKUNK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-3033
Mailing Address - Country:US
Mailing Address - Phone:802-899-4848
Mailing Address - Fax:
Practice Address - Street 1:4185 ST GEORGE RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7695
Practice Address - Country:US
Practice Address - Phone:802-651-7634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT830103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012186Medicaid