Provider Demographics
NPI:1255702502
Name:SHIREMAN, MOLLY (MA, BCBA)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:SHIREMAN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:KOSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:2997 BROADMOOR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4405
Mailing Address - Country:US
Mailing Address - Phone:719-203-4723
Mailing Address - Fax:
Practice Address - Street 1:4330 KINCAID CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4366
Practice Address - Country:US
Practice Address - Phone:719-203-4723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst