Healthcare Provider Details

I. General information

NPI: 1689383630
Provider Name (Legal Business Name): LINDA MOSES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 BRIAN WOODS
AVON CT
06001-3529
US

IV. Provider business mailing address

31 BRIAN WOODS
AVON CT
06001-3529
US

V. Phone/Fax

Practice location:
  • Phone: 860-989-4986
  • Fax:
Mailing address:
  • Phone: 860-989-4986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number3875675106
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006543
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: