Healthcare Provider Details

I. General information

NPI: 1073494274
Provider Name (Legal Business Name): MOLLY MCEACHEN LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 ENTRANOSA RD
EDGEWOOD NM
87015-9112
US

IV. Provider business mailing address

234 ENTRANOSA RD
EDGEWOOD NM
87015-9112
US

V. Phone/Fax

Practice location:
  • Phone: 505-226-5311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MOLLY MCEACHEN
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 720-280-0290