Provider Demographics
NPI:1295165199
Name:WHITEHOUSE, MOLLY H (LCSW)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:H
Last Name:WHITEHOUSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:HARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:883 PADDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-7044
Mailing Address - Country:US
Mailing Address - Phone:203-238-6877
Mailing Address - Fax:203-634-7040
Practice Address - Street 1:110 NATIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1212
Practice Address - Country:US
Practice Address - Phone:860-657-8910
Practice Address - Fax:860-657-8912
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0082831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical