Provider Demographics
NPI:1548322480
Name:MOLLICONE, LISA HARMON (MA,, LCADC, ICPS CJC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:HARMON
Last Name:MOLLICONE
Suffix:
Gender:F
Credentials:MA,, LCADC, ICPS CJC
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:HARMON MOLLICONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LCADC, ICPS CJC
Mailing Address - Street 1:205 ROUTE 9 NORTH SUITE 26
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-3068
Mailing Address - Country:US
Mailing Address - Phone:732-642-5631
Mailing Address - Fax:
Practice Address - Street 1:205 ROUTE 9 N
Practice Address - Street 2:SUITE 26
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8561
Practice Address - Country:US
Practice Address - Phone:732-642-5631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00076900101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)