Healthcare Provider Details

I. General information

NPI: 1710400551
Provider Name (Legal Business Name): JOAN MOSER CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 07/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 FRANKLIN AVE
WESTMINSTER MD
21157-5916
US

IV. Provider business mailing address

809 FRANKLIN AVE
WESTMINSTER MD
21157-5916
US

V. Phone/Fax

Practice location:
  • Phone: 410-857-8037
  • Fax:
Mailing address:
  • Phone: 410-857-8037
  • Fax: 410-848-2644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number04299
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: