Healthcare Provider Details

I. General information

NPI: 1275912990
Provider Name (Legal Business Name): MOLLY ADLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MOLLY ADLER LLC

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 ALISO DR SE
ALBUQUERQUE NM
87108-2693
US

IV. Provider business mailing address

733 ADAMS ST NE
ALBUQUERQUE NM
87110-6223
US

V. Phone/Fax

Practice location:
  • Phone: 505-916-1081
  • Fax:
Mailing address:
  • Phone: 617-784-3414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-10088
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: