Provider Demographics
NPI:1710157946
Name:HARVEY, MOLLY W (LCSW-LADC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:W
Last Name:HARVEY
Suffix:
Gender:F
Credentials:LCSW-LADC
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:J
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC LMSW-CC
Mailing Address - Street 1:78 ATLANTIC PLACE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2316
Mailing Address - Country:US
Mailing Address - Phone:207-842-6556
Mailing Address - Fax:207-842-7773
Practice Address - Street 1:12 UNION STREET
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841
Practice Address - Country:US
Practice Address - Phone:207-701-4402
Practice Address - Fax:207-701-4486
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4525101YA0400X
MELC137961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME104000000Medicaid
ME432855899Medicaid