Provider Demographics
NPI:1447646195
Name:MAFFEI, MOLLY
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:MAFFEI
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 1:140 WILLIS HEALTH BUILDING
Mailing Address - Street 2:LOCK HAVEN UNIVERSITY
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745
Mailing Address - Country:US
Mailing Address - Phone:804-852-4573
Mailing Address - Fax:
Practice Address - Street 1:401 N FAIRVIEW ST
Practice Address - Street 2:140 WILLIS HEALTH PROFESSIONAL BUILDING
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-2342
Practice Address - Country:US
Practice Address - Phone:804-852-4573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260021972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer