Healthcare Provider Details

I. General information

NPI: 1023449840
Provider Name (Legal Business Name): CHERYL MOSES LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 JOPPA CROSSING CT
JOPPA MD
21085-3741
US

IV. Provider business mailing address

332 JOPPA CROSSING CT
JOPPA MD
21085-3741
US

V. Phone/Fax

Practice location:
  • Phone: 347-604-7639
  • Fax: 999-999-9999
Mailing address:
  • Phone: 347-604-7639
  • Fax: 999-999-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19613
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: