Healthcare Provider Details

I. General information

NPI: 1376950253
Provider Name (Legal Business Name): MOLLY KATHERINE WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2014
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E MAIN ST STE 200
MILFORD MA
01757-2806
US

IV. Provider business mailing address

325 SPEEN ST APT 513
NATICK MA
01760-1566
US

V. Phone/Fax

Practice location:
  • Phone: 508-478-0207
  • Fax: 508-634-6984
Mailing address:
  • Phone: 585-919-9560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number3946-MH-B1
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: