Provider Demographics
NPI:1073087979
Name:GARBER, MOLLY (ACSW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:GARBER
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 E. HUNTINGTON DR.
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-2221
Mailing Address - Country:US
Mailing Address - Phone:626-263-9188
Mailing Address - Fax:
Practice Address - Street 1:2502 E. HUNTINGTON DR.
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2221
Practice Address - Country:US
Practice Address - Phone:626-263-9188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAACSW873661041C0700X
CA87366101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health