Healthcare Provider Details

I. General information

NPI: 1275188609
Provider Name (Legal Business Name): ANDY MOXEY LCSWC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 RITCHIE HWY STE 12F
SEVERNA PARK MD
21146-4133
US

IV. Provider business mailing address

836 RITCHIE HWY STE 12F
SEVERNA PARK MD
21146-4133
US

V. Phone/Fax

Practice location:
  • Phone: 410-670-9048
  • Fax:
Mailing address:
  • Phone: 410-670-9048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22393
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: