Provider Demographics
NPI:1508370586
Name:MOLLY ADLER LLC
Entity Type:Organization
Organization Name:MOLLY ADLER LLC
Other - Org Name:SEX THERAPY NM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:617-784-3414
Mailing Address - Street 1:733 ADAMS ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6223
Mailing Address - Country:US
Mailing Address - Phone:505-916-1081
Mailing Address - Fax:
Practice Address - Street 1:231 SIERRA DR SE STE 4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5633
Practice Address - Country:US
Practice Address - Phone:505-916-1081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-100881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM83885251Medicaid