Healthcare Provider Details

I. General information

NPI: 1841677804
Provider Name (Legal Business Name): KASEY MAY MOSS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 ANDOVER RD
WESTBROOK ME
04092-3848
US

IV. Provider business mailing address

123 ANDOVER RD
WESTBROOK ME
04092-3848
US

V. Phone/Fax

Practice location:
  • Phone: 207-761-2200
  • Fax: 207-761-2108
Mailing address:
  • Phone: 207-761-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberDO2855
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberV7394
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number22319
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number79346
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: