Healthcare Provider Details

I. General information

NPI: 1205588050
Provider Name (Legal Business Name): CHRISTOPHER JAMES MOLLICA MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 04/12/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 CHARLES ST
NORTH PROVIDENCE RI
02904-3538
US

IV. Provider business mailing address

77 WARREN ST BLDG 2
BRIGHTON MA
02135-3601
US

V. Phone/Fax

Practice location:
  • Phone: 401-400-7745
  • Fax:
Mailing address:
  • Phone: 617-787-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: