Provider Demographics
NPI:1689974370
Name:MOLINI, MARY J (LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:MOLINI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 SANTEE CT
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-2038
Mailing Address - Country:US
Mailing Address - Phone:209-327-9224
Mailing Address - Fax:209-367-8563
Practice Address - Street 1:1338 S SCHOOL ST STE A
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5700
Practice Address - Country:US
Practice Address - Phone:209-327-9224
Practice Address - Fax:209-263-7065
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist