Healthcare Provider Details

I. General information

NPI: 1225713274
Provider Name (Legal Business Name): ANDREW RYAN MOSS LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E 6TH ST
FREDERICK MD
21701-5220
US

IV. Provider business mailing address

7533 OLD RECEIVER RD
FREDERICK MD
21702-2750
US

V. Phone/Fax

Practice location:
  • Phone: 240-575-5387
  • Fax:
Mailing address:
  • Phone: 240-529-3120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30130
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: