Provider Demographics
NPI:1225822802
Name:MOLINA, CARMEN YESENIA
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:YESENIA
Last Name:MOLINA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 N HUMPHREY AVE APT H3
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2446
Mailing Address - Country:US
Mailing Address - Phone:310-283-5633
Mailing Address - Fax:
Practice Address - Street 1:3711 W DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-1413
Practice Address - Country:US
Practice Address - Phone:310-283-5633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional