Provider Demographics
NPI:1013284868
Name:BERRY, MOLLY SULLIVAN (MA)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:SULLIVAN
Last Name:BERRY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HATCH RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4212
Mailing Address - Country:US
Mailing Address - Phone:978-621-8300
Mailing Address - Fax:
Practice Address - Street 1:215 WEST ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2277
Practice Address - Country:US
Practice Address - Phone:508-902-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker