Individual
MRS. MOLLY ELIZABETH MODICA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
475 LAWRENCE RD, BROOMALL, PA 19008-3747
(484) 450-6476
(610) 544-7142
Mailing address
475 LAWRENCE RD, BROOMALL, PA 19008-3747
(484) 450-6476
(610) 544-7142
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
106H00000X
Marriage & Family Therapist
Primary
MF000772
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102918632
—
PA
Enumeration date
03/06/2014
Last updated
04/30/2015
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