Healthcare Provider Details

I. General information

NPI: 1275913709
Provider Name (Legal Business Name): MOLLY ZIVE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 EL CAJON BLVD STE A
SAN DIEGO CA
92103-2591
US

IV. Provider business mailing address

1835 EL CAJON BLVD STE A
SAN DIEGO CA
92103-2591
US

V. Phone/Fax

Practice location:
  • Phone: 513-454-5312
  • Fax:
Mailing address:
  • Phone: 513-454-5312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW66877
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number83199
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: