Provider Demographics
NPI:1598451999
Name:MOLLY ANNE EISEN-KEARNS, LICENSED CLINICAL SOCIAL WORKER INC.
Entity Type:Organization
Organization Name:MOLLY ANNE EISEN-KEARNS, LICENSED CLINICAL SOCIAL WORKER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:EISEN-KEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-385-4855
Mailing Address - Street 1:4565 MANANITA AVE
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-3068
Mailing Address - Country:US
Mailing Address - Phone:561-385-4855
Mailing Address - Fax:
Practice Address - Street 1:4565 MANANITA AVE
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-3068
Practice Address - Country:US
Practice Address - Phone:561-385-4855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty