Healthcare Provider Details

I. General information

NPI: 1780022558
Provider Name (Legal Business Name): MOLLY ELIZABETH THOMAS LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E WALNUT ST
LANCASTER OH
43130-4464
US

IV. Provider business mailing address

220 E WALNUT ST
LANCASTER OH
43130-4464
US

V. Phone/Fax

Practice location:
  • Phone: 740-277-6043
  • Fax:
Mailing address:
  • Phone: 740-689-6758
  • Fax: 740-689-6759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1201204
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1502452-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: