Provider Demographics
NPI:1922680636
Name:MOLINA, LAURA NATALY
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:NATALY
Last Name:MOLINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LINCON KNOLL LANE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803
Mailing Address - Country:US
Mailing Address - Phone:818-241-6789
Mailing Address - Fax:
Practice Address - Street 1:6 LINCON KNOLL LANE
Practice Address - Street 2:SUITE 104
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-0180
Practice Address - Country:US
Practice Address - Phone:818-241-6789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician