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NPI Code Detail

MEDICARE: SAMANTHA ALEXIS MOSS LCSW

MEDICARE: SAMANTHA ALEXIS MOSS LCSW
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
1101YM0800XMental Health Counselor60353CA
21041C0700XClinical Social Worker80827CA

General Provider Information

NPI Number : 1821429697
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA ALEXIS MOSS LCSW
Provider Business Mailing Address
First Line : 6345 BALBOA BLVD STE 310
Second Line :
City : ENCINO
State : CA
Zip : 91316-1500
Country : US
Telephone Number : 818-312-2100
Fax Number :
Provider Business Practice Location Address
First Line : 4325 W SUNSET BLVD STE 206
Second Line :
City : LOS ANGELES
State : CA
Zip : 90029-2180
Country : US
Telephone Number : 310-388-7983
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2013
Last Update Date : 06/14/2019

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