Provider Demographics
NPI:1265546857
Name:MOLINO, RONALD ALDO (LCSW)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:ALDO
Last Name:MOLINO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 STUYVESANT OVAL
Mailing Address - Street 2:1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2242
Mailing Address - Country:US
Mailing Address - Phone:212-777-4257
Mailing Address - Fax:
Practice Address - Street 1:18 STUYVESANT OVAL
Practice Address - Street 2:1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-2242
Practice Address - Country:US
Practice Address - Phone:212-777-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO19661-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01884422Medicaid
NYN2L901Medicare ID - Type Unspecified