1023159191 NPI number — DR. MICHAEL A. MOLYN PSY.D.

Table of content: DR. MICHAEL A. MOLYN PSY.D. (NPI 1023159191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023159191 NPI number — DR. MICHAEL A. MOLYN PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLYN
Provider First Name:
MICHAEL
Provider Middle Name:
A.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023159191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1067 CRESTLINE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL DORADO HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95762-7224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-870-4484
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VALLEY PSYCHOLOGICAL CENTER
Provider Second Line Business Practice Location Address:
1891 E. ROSEVILLE PARKWAY, SUITE 100
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-870-4484
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY 21341 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PSY 21341 . This is a "CA PSYCHOLOGY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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