Healthcare Provider Details

I. General information

NPI: 1306592282
Provider Name (Legal Business Name): MOLLY BARAK LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 N 4TH ST
BROOKLYN NY
11249-3296
US

IV. Provider business mailing address

200 E 33RD ST APT 8E
NEW YORK NY
10016-4827
US

V. Phone/Fax

Practice location:
  • Phone: 646-450-7748
  • Fax:
Mailing address:
  • Phone: 516-404-2816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number014068
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: