Basic Information
| Provider Information | |||||||||
| NPI: | 1558764423 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEA | ||||||||
| FirstName: | MOLLY | ||||||||
| MiddleName: | REBECCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 148 WILSON AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112378042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176125787 | ||||||||
| FaxNumber: | 3476300519 | ||||||||
| Practice Location | |||||||||
| Address1: | 71 W 23RD ST FL 7 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100104102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125764195 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2014 | ||||||||
| LastUpdateDate: | 11/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 092338 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.