Provider Demographics
NPI:1568480481
Name:LIGHT, MOLLY JACOBSON (MSW)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:JACOBSON
Last Name:LIGHT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 VARDA LNDG
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1417
Mailing Address - Country:US
Mailing Address - Phone:415-332-1189
Mailing Address - Fax:
Practice Address - Street 1:66 VARDA LNDG
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1417
Practice Address - Country:US
Practice Address - Phone:415-332-1189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 92721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical