Provider Demographics
NPI:1497104764
Name:MOLINARO, MARISA (BS)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:MOLINARO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 PROVIDENCE RD # 224
Mailing Address - Street 2:
Mailing Address - City:WHITINSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01588-2134
Mailing Address - Country:US
Mailing Address - Phone:508-603-9881
Mailing Address - Fax:
Practice Address - Street 1:80 WORCESTER ST STE 10
Practice Address - Street 2:
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536-1043
Practice Address - Country:US
Practice Address - Phone:508-603-9881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11741101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health