Provider Demographics
NPI:1902536592
Name:MOLEDOR, LAURA (LISW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MOLEDOR
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 110
Mailing Address - Street 2:
Mailing Address - City:AMLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43002-0110
Mailing Address - Country:US
Mailing Address - Phone:567-323-4241
Mailing Address - Fax:
Practice Address - Street 1:5214F DIAMOND HEIGHTS BLVD # 3422
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-2175
Practice Address - Country:US
Practice Address - Phone:567-323-4241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.08003611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical