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NPI Code Detail

MEDICARE: MS. MOLLY DANA STANLEY LCSW

MEDICARE: MS. MOLLY DANA STANLEY 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 Worker1185ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111540840OTHERMECAQH
2008414OTHERMEANTHEM BLUE CROSS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487634473
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MOLLY DANA STANLEY LCSW
Provider Business Mailing Address
First Line : 345 COTTAGE RD
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-3919
Country : US
Telephone Number : 207-799-2099
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 : 207-799-2099
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2006
Last Update Date : 11/09/2012

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