Healthcare Provider Details

I. General information

NPI: 1932138054
Provider Name (Legal Business Name): ANNE MOSELEY-WISS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 3 PONDS RD
WAYLAND MA
01778-2008
US

IV. Provider business mailing address

7 3 PONDS RD
WAYLAND MA
01778-2008
US

V. Phone/Fax

Practice location:
  • Phone: 508-859-4111
  • Fax: 978-372-6736
Mailing address:
  • Phone: 508-358-2264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105678
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier62-00196
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerEVERCARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: