Healthcare Provider Details

I. General information

NPI: 1164363883
Provider Name (Legal Business Name): MOLLY MCCONNELL
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 GROVE WAY
CASTRO VALLEY CA
94546-6703
US

IV. Provider business mailing address

943 S WOLFE RD
SUNNYVALE CA
94086-8807
US

V. Phone/Fax

Practice location:
  • Phone: 510-688-8166
  • Fax:
Mailing address:
  • Phone: 408-599-4330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: