Provider Demographics
NPI:1073339727
Name:MOLLICA TRAINA, CORINNE
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:MOLLICA TRAINA
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 1:99 GARIBALDI AVE
Mailing Address - Street 2:
Mailing Address - City:ROSETO
Mailing Address - State:PA
Mailing Address - Zip Code:18013-1384
Mailing Address - Country:US
Mailing Address - Phone:718-873-7613
Mailing Address - Fax:
Practice Address - Street 1:99 GARIBALDI AVE
Practice Address - Street 2:
Practice Address - City:ROSETO
Practice Address - State:PA
Practice Address - Zip Code:18013-1384
Practice Address - Country:US
Practice Address - Phone:718-873-7613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty