Healthcare Provider Details

I. General information

NPI: 1922412071
Provider Name (Legal Business Name): LAURIE ANN MOSES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 FAY DR
MARY ESTHER FL
32569-2131
US

IV. Provider business mailing address

5214F DIAMOND HEIGHTS BLVD # 3422
SAN FRANCISCO CA
94131-2175
US

V. Phone/Fax

Practice location:
  • Phone: 448-250-2105
  • Fax:
Mailing address:
  • Phone: 415-360-3348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100488
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC016263
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26541
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: