Provider Demographics
NPI:1902064538
Name:EISLEY, MOLLY ANN (LSW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANN
Last Name:EISLEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-6001
Mailing Address - Country:US
Mailing Address - Phone:570-322-7873
Mailing Address - Fax:570-322-8026
Practice Address - Street 1:435 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6001
Practice Address - Country:US
Practice Address - Phone:570-322-7873
Practice Address - Fax:570-322-8026
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126857104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker