Provider Demographics
NPI:1821607151
Name:MOLLOY, CHARLOTTE (CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:CHARLOTTE
Middle Name:
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HARVARD RD S
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY SOUTH
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5213
Mailing Address - Country:US
Mailing Address - Phone:516-565-5544
Mailing Address - Fax:
Practice Address - Street 1:1560 MAYFLOWER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5400
Practice Address - Country:US
Practice Address - Phone:718-948-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist