Provider Demographics
NPI:1215152822
Name:MOLLICA-MINSON, MARION ROSE (PSYCHOTHERAPIST)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:ROSE
Last Name:MOLLICA-MINSON
Suffix:
Gender:F
Credentials:PSYCHOTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 NW BOCA RATON BLVD
Mailing Address - Street 2:#104
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4879
Mailing Address - Country:US
Mailing Address - Phone:561-999-9890
Mailing Address - Fax:561-999-9454
Practice Address - Street 1:4710 NW BOCA RATON BLVD
Practice Address - Street 2:#104
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4879
Practice Address - Country:US
Practice Address - Phone:561-999-9890
Practice Address - Fax:561-999-9454
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4781101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health