Provider Demographics
NPI:1770646465
Name:HAUCK, MOLLY PERKINS (PHD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:PERKINS
Last Name:HAUCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6209 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3906
Mailing Address - Country:US
Mailing Address - Phone:301-881-4884
Mailing Address - Fax:301-881-5447
Practice Address - Street 1:6209 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3906
Practice Address - Country:US
Practice Address - Phone:301-881-4884
Practice Address - Fax:301-881-5447
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02128103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD101600800Medicaid
MD1770646465Medicare NSC
MD101600800Medicaid