Provider Demographics
NPI:1265067573
Name:MOLINO, VICTORIA E
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:E
Last Name:MOLINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 DRAHOS DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12009-9202
Mailing Address - Country:US
Mailing Address - Phone:518-852-7700
Mailing Address - Fax:
Practice Address - Street 1:880 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-1229
Practice Address - Country:US
Practice Address - Phone:518-881-3995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0853021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical