Provider Demographics
NPI:1962093351
Name:MOLLOY, JOSEPH (CASAC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MOLLOY
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ROCKLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-5960
Mailing Address - Country:US
Mailing Address - Phone:914-944-5220
Mailing Address - Fax:914-941-1289
Practice Address - Street 1:22 ROCKLEDGE AVE
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-5960
Practice Address - Country:US
Practice Address - Phone:914-944-5220
Practice Address - Fax:914-941-1289
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10215101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)