Healthcare Provider Details

I. General information

NPI: 1942497995
Provider Name (Legal Business Name): ELIZABETH S MOODY MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 02/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 ROUTE 202 S
FAR HILLS NJ
07931
US

IV. Provider business mailing address

PO BOX 472
FAR HILLS NJ
07931-0472
US

V. Phone/Fax

Practice location:
  • Phone: 908-306-1300
  • Fax:
Mailing address:
  • Phone: 908-306-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05247700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: