Provider Demographics
NPI:1851192553
Name:FOTUSKY, MOLLY ELIZABETH LYNN (LPMFT)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ELIZABETH LYNN
Last Name:FOTUSKY
Suffix:
Gender:
Credentials:LPMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 HYDE ST
Mailing Address - Street 2:
Mailing Address - City:WHITNEY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:13862-2408
Mailing Address - Country:US
Mailing Address - Phone:607-206-7840
Mailing Address - Fax:607-206-7840
Practice Address - Street 1:3001 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-5843
Practice Address - Country:US
Practice Address - Phone:607-754-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist