Provider Demographics
NPI:1427882695
Name:MOLLICA, NICOLE PAPPAS (MSSA, LSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:PAPPAS
Last Name:MOLLICA
Suffix:
Gender:F
Credentials:MSSA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 SHARON CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-4947
Mailing Address - Country:US
Mailing Address - Phone:513-433-4388
Mailing Address - Fax:513-217-1161
Practice Address - Street 1:220 S BREIEL BLVD STE C
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5106
Practice Address - Country:US
Practice Address - Phone:513-433-4388
Practice Address - Fax:513-217-1161
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.17007201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty