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NPI Code Detail

MEDICARE: JUDITH MOLL LCSW

MEDICARE: JUDITH MOLL 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 WorkerLC4856ME

General Provider Information

NPI Number : 1396753117
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDITH MOLL LCSW
Provider Business Mailing Address
First Line : 27 MERRIMAC PL
Second Line :
City : CAPE ELIZABETH
State : ME
Zip : 04107-1624
Country : US
Telephone Number : 207-767-3096
Fax Number :
Provider Business Practice Location Address
First Line : 345 COTTAGE RD
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-3919
Country : US
Telephone Number : 207-767-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2006
Last Update Date : 07/08/2007

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