Individual
MOLLIE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
1430 MAIN ST, WALTHAM, MA 02451-1623
(781) 647-5327
Mailing address
1430 MAIN ST, WALTHAM, MA 02451-1623
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042104356
JEWISH FAMILY AND CHILDREN'S SERVICES
MA
Enumeration date
05/23/2015
Last updated
05/23/2015
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