Provider Demographics
NPI:1881900728
Name:DEAN, MOLLY (LCSW)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4647 N 32ND ST
Mailing Address - Street 2:SUITE 255
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3345
Mailing Address - Country:US
Mailing Address - Phone:480-200-0410
Mailing Address - Fax:
Practice Address - Street 1:4647 N 32ND ST
Practice Address - Street 2:SUITE 255
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3345
Practice Address - Country:US
Practice Address - Phone:480-200-0410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-135801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ704245Medicaid