Provider Demographics
NPI:1720796444
Name:BERLIN, MOLLY (QBA)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:BERLIN
Suffix:
Gender:F
Credentials:QBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9823 CORDOVA VISTA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7235
Mailing Address - Country:US
Mailing Address - Phone:424-298-0972
Mailing Address - Fax:
Practice Address - Street 1:4623 W DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-7116
Practice Address - Country:US
Practice Address - Phone:702-410-9629
Practice Address - Fax:702-410-9644
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health