MEDICARE: MS. DIANE E MOSS

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	101YM0800X	Mental Health Counselor	PC-0000334	DE

General Provider Information

NPI Number	:	1710164280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANE E MOSS

Provider Business Mailing Address
First Line	:	1004 N MONROE ST
Second Line	:	TRINITY VICINITY
City	:	WILMINGTON
State	:	DE
Zip	:	19801-1339
Country	:	US
Telephone Number	:	302-893-1001
Fax Number	:	302-655-2474

Provider Business Practice Location Address
First Line	:	1004 N MONROE ST
Second Line	:	TRINITY VICINITY
City	:	WILMINGTON
State	:	DE
Zip	:	19801-1339
Country	:	US
Telephone Number	:	302-893-1001
Fax Number	:	302-655-2474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	01/28/2008

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