MEDICARE: MICHELA MOL 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	1041C0700X	Clinical Social Worker	4195	HI

General Provider Information

NPI Number	:	1992243950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELA MOL LCSW

Provider Business Mailing Address
First Line	:	55 S KUKUI ST APT 1210
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813-2311
Country	:	US
Telephone Number	:	808-779-6593
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 S KUKUI ST APT 1210
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813-2311
Country	:	US
Telephone Number	:	808-779-6593
Fax Number	:

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

Provider Enumeration Date	:	02/09/2017
Last Update Date	:	02/09/2017

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Directions to “ MICHELA MOL LCSW” Practice Location

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