Provider Demographics
NPI:1992869697
Name:MOLLOY, MICHAEL CHRISTOPHER (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHRISTOPHER
Last Name:MOLLOY
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 MILLER ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:WALLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07057-2209
Mailing Address - Country:US
Mailing Address - Phone:201-933-5766
Mailing Address - Fax:
Practice Address - Street 1:87 MILLER ST
Practice Address - Street 2:SUITE #1
Practice Address - City:WALLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07057-2209
Practice Address - Country:US
Practice Address - Phone:201-933-5766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055883-1104100000X
NJ44SC047463001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ089469Medicare ID - Type Unspecified