Active NPI
Molly Elizabeth Modica, LMFT
- Marriage & Family Therapist
- Broomall, PA
National Provider Identifier
1689090268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MF000772
- Practice address
- 475 Lawrence Rd
Broomall, PA 19008-3747 - Phone
- (484) 450-6476
- Fax
- (610) 544-7142
- NPI assigned
- Mar 6, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | |||
| Marriage & Family Therapist | 106H00000X | MF000772 | PA | Primary |
Addresses
Primary practice location
475 Lawrence Rd
Broomall, PA 19008-3747
Mailing address
475 Lawrence Rd
Broomall, PA 19008-3747
Phone (484) 450-6476
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102918632 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MF000772 | PA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spectra Support Services, LLC | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1394064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430352000000",
"number": "1689090268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "475 LAWRENCE RD",
"city": "BROOMALL",
"state": "PA",
"postal_code": "190083747",
"telephone_number": "484-450-6476",
"fax_number": "610-544-7142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "475 LAWRENCE RD",
"city": "BROOMALL",
"state": "PA",
"postal_code": "190083747",
"telephone_number": "484-450-6476",
"fax_number": "610-544-7142"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MODICA",
"first_name": "MOLLY",
"middle_name": "ELIZABETH",
"name_prefix": "Mrs.",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-03-06",
"last_updated": "2015-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "PA",
"license": "MF000772",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102918632",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Broomall, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.