=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790549053
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOLLY ANNE GEARAN LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2024
-----------------------------------------------------
Last Update Date | 02/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 460 W 41ST ST OFC 418
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10036-6801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-891-5093
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 608 37TH ST FL 3
-----------------------------------------------------
City | UNION CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07087-2515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-626-5913
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 122160-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------