Provider Demographics
NPI:1841688819
Name:BOXALL, MOLLY (MED, BCBA)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:
Last Name:BOXALL
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:GORMLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8500 WASHINGTON ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1846
Mailing Address - Country:US
Mailing Address - Phone:505-828-3837
Mailing Address - Fax:
Practice Address - Street 1:8500 WASHINGTON ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1846
Practice Address - Country:US
Practice Address - Phone:505-828-3837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst