Provider Demographics
NPI:1336575760
Name:MOLLY PERKINS HAUCK, PH.D., LLC
Entity type:Organization
Organization Name:MOLLY PERKINS HAUCK, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:PERKINS
Authorized Official - Last Name:HAUCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-881-4884
Mailing Address - Street 1:3900 DECATUR AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1531
Mailing Address - Country:US
Mailing Address - Phone:301-881-4884
Mailing Address - Fax:301-881-5447
Practice Address - Street 1:3900 DECATUR AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1531
Practice Address - Country:US
Practice Address - Phone:301-881-4884
Practice Address - Fax:301-881-5447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 251S00000X
MD02128103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD101600800Medicaid
MD1750529186Medicare NSC
MD1770646465Medicare NSC