Provider Demographics
NPI:1790355014
Name:STEVENSON, MOLLY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SPRINGFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2029
Mailing Address - Country:US
Mailing Address - Phone:856-304-9388
Mailing Address - Fax:
Practice Address - Street 1:304 NEWTON AVE
Practice Address - Street 2:
Practice Address - City:OAKLYN
Practice Address - State:NJ
Practice Address - Zip Code:08107-1446
Practice Address - Country:US
Practice Address - Phone:856-425-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00538400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health