Provider Demographics
NPI:1861543050
Name:MOLLEN, ANNE (MSW)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:MOLLEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2471 TERRILL RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6627
Mailing Address - Country:US
Mailing Address - Phone:908-687-6093
Mailing Address - Fax:
Practice Address - Street 1:500 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1027
Practice Address - Country:US
Practice Address - Phone:973-467-3300
Practice Address - Fax:973-476-2362
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC003560001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ651906Medicare ID - Type Unspecified10