Provider Demographics
NPI:1669972790
Name:MOLLICA, JULIE LYNNE (LICENSED INDEPENDENT)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LYNNE
Last Name:MOLLICA
Suffix:
Gender:F
Credentials:LICENSED INDEPENDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 FLAX POND ROAD
Mailing Address - Street 2:BREWSTER TREATMENT PROGRAM, OLD COLONY YMCA
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631
Mailing Address - Country:US
Mailing Address - Phone:508-896-9700
Mailing Address - Fax:508-896-8706
Practice Address - Street 1:456 FLAX POND ROAD
Practice Address - Street 2:BREWSTER TREATMENT PROGRAM, OLD COLONY YMCA
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631
Practice Address - Country:US
Practice Address - Phone:508-896-9700
Practice Address - Fax:508-896-8706
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10297701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical