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NPI Code Detail

MEDICARE: MOLLI CLEETON LCSW

MEDICARE:   MOLLI  CLEETON  LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerSW19624FL

General Provider Information

NPI Number : 1104555465
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLI CLEETON LCSW
Provider Business Mailing Address
First Line : 2807 W BUSCH BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33618-4562
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2807 W BUSCH BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33618-4562
Country : US
Telephone Number : 813-702-1762
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2022
Last Update Date : 06/09/2022

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Directions to “ MOLLI CLEETON LCSW” Practice Location

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