Provider Demographics
NPI:1184375024
Name:MOLAK, BRIAR DIANE
Entity type:Individual
Prefix:
First Name:BRIAR
Middle Name:DIANE
Last Name:MOLAK
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 1:609 GARDNERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1668
Mailing Address - Country:US
Mailing Address - Phone:716-440-4095
Mailing Address - Fax:
Practice Address - Street 1:279 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1624
Practice Address - Country:US
Practice Address - Phone:845-255-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115259104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker