Provider Demographics
NPI:1912226754
Name:MOLLY DELANEY, PSYD, INC
Entity Type:Organization
Organization Name:MOLLY DELANEY, PSYD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DELANEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:207-563-8522
Mailing Address - Street 1:33 WHITE OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4257
Mailing Address - Country:US
Mailing Address - Phone:207-563-8522
Mailing Address - Fax:
Practice Address - Street 1:33 WHITE OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4257
Practice Address - Country:US
Practice Address - Phone:207-563-8522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1075103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILME0348Medicare Oscar/Certification