=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174747612
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOLLIE R SOKOLOV LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2007
-----------------------------------------------------
Last Update Date | 10/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 134 MAIN ST SUITE 2A
-----------------------------------------------------
City | NEW PALTZ
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12561-1128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-819-2348
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 134 MAIN ST SUITE 2 A
-----------------------------------------------------
City | NEW PALTZ
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12561-1128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-373-6042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R029114
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------