Provider Demographics
NPI:1710600895
Name:SMITH, MOLLY BRIGID
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:BRIGID
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 FORT WASHINGTON AVE APT 32
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4714
Mailing Address - Country:US
Mailing Address - Phone:610-533-2899
Mailing Address - Fax:
Practice Address - Street 1:1600 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-8059
Practice Address - Country:US
Practice Address - Phone:610-533-2899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist