Provider Demographics
NPI:1700451747
Name:MCCRACKEN, MOLLY ADRIENNE (LMSW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ADRIENNE
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7323 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4313
Mailing Address - Country:US
Mailing Address - Phone:202-413-8629
Mailing Address - Fax:
Practice Address - Street 1:7323 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4313
Practice Address - Country:US
Practice Address - Phone:202-413-8629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26243104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker