Healthcare Provider Details

I. General information

NPI: 1508370586
Provider Name (Legal Business Name): MOLLY ADLER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 SIERRA DR SE STE 4
ALBUQUERQUE NM
87108-5633
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: 505-916-1081
  • 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: MOLLY ADLER
Title or Position: OWNER
Credential: LCSW
Phone: 617-784-3414