MEDICARE: CHARLOTTE GLENN MOLALI LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	117621	CA

General Provider Information

NPI Number	:	1053913251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE GLENN MOLALI LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1209
Second Line	:
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-3209
Country	:	US
Telephone Number	:	259-272-0707
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 SAND CREEK RD
Second Line	:
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-2215
Country	:	US
Telephone Number	:	925-663-8158
Fax Number	:	925-523-0916

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2020
Last Update Date	:	08/20/2024

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