Provider Demographics
NPI:1093962151
Name:MOLTMAN, BEN (MFT-I)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:MOLTMAN
Suffix:
Gender:M
Credentials:MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2736
Mailing Address - Country:US
Mailing Address - Phone:415-370-5129
Mailing Address - Fax:
Practice Address - Street 1:248 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2736
Practice Address - Country:US
Practice Address - Phone:415-370-5129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPPLICANT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health