Provider Demographics
NPI:1760514483
Name:MOLINOFF, ADA (PHD)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:MOLINOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ADA
Other - Middle Name:M
Other - Last Name:HAWKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:635 CHURCH ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2402
Mailing Address - Country:US
Mailing Address - Phone:503-399-8264
Mailing Address - Fax:503-399-9401
Practice Address - Street 1:635 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2402
Practice Address - Country:US
Practice Address - Phone:503-399-8264
Practice Address - Fax:503-399-9401
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0641103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical