Healthcare Provider Details

I. General information

NPI: 1508405663
Provider Name (Legal Business Name): MARIA MOLLICA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 WALNUT HILL LN
DALLAS TX
75231-4426
US

IV. Provider business mailing address

2735 VILLA CREEK DR
DALLAS TX
75234-7454
US

V. Phone/Fax

Practice location:
  • Phone: 972-620-2077
  • Fax:
Mailing address:
  • Phone: 972-620-2077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: