Healthcare Provider Details

I. General information

NPI: 1386896975
Provider Name (Legal Business Name): ERIKA MOSES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 MAIN ST # 513
MIDDLETOWN CT
06457-3359
US

IV. Provider business mailing address

39 WALL ST
MIDDLETOWN CT
06457-4705
US

V. Phone/Fax

Practice location:
  • Phone: 203-756-8317
  • Fax: 203-756-8310
Mailing address:
  • Phone: 203-558-2381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7719
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: