Provider Demographics
NPI:1831912898
Name:WIPF, MOLLY
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:WIPF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 REID AVE
Mailing Address - Street 2:
Mailing Address - City:BREEZY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11697-1916
Mailing Address - Country:US
Mailing Address - Phone:917-991-8054
Mailing Address - Fax:
Practice Address - Street 1:157 E 72ND ST OFC J
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4333
Practice Address - Country:US
Practice Address - Phone:917-991-8054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-PI32359-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health