Provider Demographics
NPI:1427239177
Name:MOLLER, MILDRED WILLIAMS (PT)
Entity type:Individual
Prefix:MRS
First Name:MILDRED
Middle Name:WILLIAMS
Last Name:MOLLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 ADELINE ST
Mailing Address - Street 2:B
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-4433
Mailing Address - Country:US
Mailing Address - Phone:510-834-0516
Mailing Address - Fax:
Practice Address - Street 1:2804 ADELINE ST
Practice Address - Street 2:B
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-4433
Practice Address - Country:US
Practice Address - Phone:510-834-0516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24393101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT24393OtherPSYCHIATRIC TEHNICIAN