MEDICARE: MRS. HEIDI ANN MOSS LISW-CP

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	5207	SC

General Provider Information

NPI Number	:	1851539878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEIDI ANN MOSS LISW-CP

Provider Business Mailing Address
First Line	:	153 N SPRING ST
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29306-2309
Country	:	US
Telephone Number	:	864-316-6835
Fax Number	:	864-580-5460

Provider Business Practice Location Address
First Line	:	153 N SPRING ST
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29306-2309
Country	:	US
Telephone Number	:	864-316-6835
Fax Number	:	864-580-5460

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

Provider Enumeration Date	:	01/29/2009
Last Update Date	:	03/17/2018

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