MEDICARE: MOSS MIRROR LCSW, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1558226712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSS MIRROR LCSW, PLLC

Provider Business Mailing Address
First Line	:	51 QUEEN ANNE LN
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-6013
Country	:	US
Telephone Number	:	607-437-3158
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 QUEEN ANNE LN
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-6013
Country	:	US
Telephone Number	:	607-437-3158
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MICHAELA MURPHY
Credential	:	LCSW
Telephone Number	:	631-485-6507

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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