Provider Demographics
NPI:1073199337
Name:MAYER, MOLLY ANN (LGSW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANN
Last Name:MAYER
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MASSACHUSETTS AVE NW APT 208
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-1816
Mailing Address - Country:US
Mailing Address - Phone:248-330-0733
Mailing Address - Fax:
Practice Address - Street 1:1627 K ST NW STE 500
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1708
Practice Address - Country:US
Practice Address - Phone:202-515-1993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50083239104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker