Basic Information
| Provider Information | |||||||||
| NPI: | 1952921249 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RENDINA | ||||||||
| FirstName: | MOLLY | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5633 DESCARTES CIR | ||||||||
| Address2: | |||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334722425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612795010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3185 BOUTWELL RD | ||||||||
| Address2: | |||||||||
| City: | LAKE WORTH BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334612610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615330074 | ||||||||
| FaxNumber: | 5615330087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2020 | ||||||||
| LastUpdateDate: | 04/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH17498 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.