Provider Demographics
NPI:1427697804
Name:DESMOND, MOLLY
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:DESMOND
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 1:26 MELENDY RD UNIT 89
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-3473
Mailing Address - Country:US
Mailing Address - Phone:603-554-4131
Mailing Address - Fax:
Practice Address - Street 1:26 MELENDY RD UNIT 89
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-3473
Practice Address - Country:US
Practice Address - Phone:603-554-4131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician