Healthcare Provider Details

I. General information

NPI: 1326392796
Provider Name (Legal Business Name): MOLLY L. MAZER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 CARLISLE BLVD NE STE G
ALBUQUERQUE NM
87107-4532
US

IV. Provider business mailing address

1414 CORNELL DR NE
ALBUQUERQUE NM
87106-3702
US

V. Phone/Fax

Practice location:
  • Phone: 401-954-1397
  • Fax: 505-200-2177
Mailing address:
  • Phone: 401-954-1397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09016
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: