Provider Demographics
NPI:1639845902
Name:STAYER, MOLLY (LMSW)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:STAYER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7633 TOTMAN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-1866
Mailing Address - Country:US
Mailing Address - Phone:315-447-9848
Mailing Address - Fax:
Practice Address - Street 1:113 SCHUYLER ST STE 2
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1600
Practice Address - Country:US
Practice Address - Phone:315-385-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty