Healthcare Provider Details

I. General information

NPI: 1912423328
Provider Name (Legal Business Name): SANDRA MOSCOSO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA ROBINSON LCSW

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 W LINCOLN TRAIL BLVD
RADCLIFF KY
40160-3302
US

IV. Provider business mailing address

1115 WOODDALE RD
BRANDENBURG KY
40108-1133
US

V. Phone/Fax

Practice location:
  • Phone: 270-268-2228
  • Fax:
Mailing address:
  • Phone: 502-434-8376
  • Fax: 502-473-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: