Provider Demographics
NPI:1326392796
Name:MAZER, MOLLY L (LCSW)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:L
Last Name:MAZER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 CORNELL DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3702
Mailing Address - Country:US
Mailing Address - Phone:401-954-1397
Mailing Address - Fax:
Practice Address - Street 1:4010 CARLISLE BLVD NE STE G
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4532
Practice Address - Country:US
Practice Address - Phone:401-954-1397
Practice Address - Fax:505-200-2177
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-090161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical