Provider Demographics
NPI:1740562974
Name:MOLLO, SHYLA MAE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHYLA
Middle Name:MAE
Last Name:MOLLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2756 POST RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-3003
Mailing Address - Country:US
Mailing Address - Phone:401-691-6000
Mailing Address - Fax:401-738-7718
Practice Address - Street 1:2756 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-3003
Practice Address - Country:US
Practice Address - Phone:401-691-6000
Practice Address - Fax:401-738-7718
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW013251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical