Provider Demographics
NPI:1174976294
Name:LENNON, MOLLY (LABA)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:LENNON
Suffix:
Gender:F
Credentials:LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WORCESTER ST APT 5
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3911
Mailing Address - Country:US
Mailing Address - Phone:781-608-6087
Mailing Address - Fax:
Practice Address - Street 1:65 WORCESTER ST APT 5
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3911
Practice Address - Country:US
Practice Address - Phone:781-608-6087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA740103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst