MEDICARE: MATTHEW STEVEN MOLLENHAUER 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
1	101Y00000X	Counselor	ASW85762	CA
2	1041C0700X	Clinical Social Worker	LCSW103794	CA

General Provider Information

NPI Number	:	1861962235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW STEVEN MOLLENHAUER LCSW

Provider Business Mailing Address
First Line	:	8844 FARGO LN
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-9671
Country	:	US
Telephone Number	:	530-391-7491
Fax Number	:

Provider Business Practice Location Address
First Line	:	3415 S SEPULVEDA BLVD FL 11
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-6060
Country	:	US
Telephone Number	:	530-672-1785
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2018
Last Update Date	:	06/12/2025

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