Healthcare Provider Details

I. General information

NPI: 1982567723
Provider Name (Legal Business Name): MOLLY OAKE WARREN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 HANCOCK ST
ELLSWORTH ME
04605-2021
US

IV. Provider business mailing address

79 HANCOCK ST
ELLSWORTH ME
04605-2021
US

V. Phone/Fax

Practice location:
  • Phone: 207-205-3936
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC25124
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: