Provider Demographics
NPI:1154748853
Name:MOLNAR, JAMIE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:MOLNAR
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 1:2142 WALDEMERE ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2313
Mailing Address - Country:US
Mailing Address - Phone:941-735-2939
Mailing Address - Fax:
Practice Address - Street 1:950 S TAMIAMI TRL
Practice Address - Street 2:SUITE 202
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7840
Practice Address - Country:US
Practice Address - Phone:941-735-2939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 11472101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health