Provider Demographics
NPI:1982427589
Name:BLANK, MOLLY (LMSW)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:BLANK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2546 E 17TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3561
Mailing Address - Country:US
Mailing Address - Phone:646-470-4174
Mailing Address - Fax:888-280-7590
Practice Address - Street 1:2546 E 17TH ST STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3561
Practice Address - Country:US
Practice Address - Phone:646-470-4174
Practice Address - Fax:888-280-7590
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker