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General NPI Number Information
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NPI Number | 1336532597
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Entity Type | Individual
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Provider Name | JUDITH MOOLTEN CSW, PHDC, ST
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Gender | Female
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 20 WALNUT AVE
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City | WHEELING
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State | WV
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Zip | 26003-5727
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Country | US
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Telephone | 304-232-0230
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Fax | 866-519-8020
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Provider Business Mailing Address
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Address Line | 20 WALNUT AVE
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City | WHEELING
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State | WV
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Zip | 26003-5727
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Country | US
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Telephone | 304-232-0230
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Fax | 866-519-8020
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8866713230
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License Number State | WV
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