Provider Demographics
NPI:1437667987
Name:MOLLETTE, NILERISHA (LMSW)
Entity type:Individual
Prefix:MS
First Name:NILERISHA
Middle Name:
Last Name:MOLLETTE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:NILERISHA
Other - Middle Name:
Other - Last Name:MOLLETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:46 COBBLESTONE LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-5091
Mailing Address - Country:US
Mailing Address - Phone:917-565-0614
Mailing Address - Fax:
Practice Address - Street 1:210 E MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4038
Practice Address - Country:US
Practice Address - Phone:845-513-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker