Provider Demographics
NPI:1144911447
Name:MOLINA, JAZMIN (LADC)
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:
Last Name:MOLINA
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 BLACKSTONE VLG
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-2417
Mailing Address - Country:US
Mailing Address - Phone:860-729-8391
Mailing Address - Fax:
Practice Address - Street 1:525 WOLCOTT ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-1250
Practice Address - Country:US
Practice Address - Phone:203-568-6190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00809101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)