Individual
MS. MOLLY DANA STANLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
345 COTTAGE RD, SOUTH PORTLAND, ME 04106-3919
(207) 799-2099
Mailing address
345 COTTAGE RD, SOUTH PORTLAND, ME 04106-3919
(207) 799-2099
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1185
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008414
ANTHEM BLUE CROSS
ME
05
—
010424754
—
ME
01
—
11540840
CAQH
ME
Enumeration date
01/18/2006
Last updated
11/09/2012
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