Healthcare Provider Details

I. General information

NPI: 1295954543
Provider Name (Legal Business Name): SHARON L MOSS MSW,LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 WYOK RD
JOHNSON CITY NY
13790-4223
US

IV. Provider business mailing address

14 LEROY ST
BINGHAMTON NY
13905-4603
US

V. Phone/Fax

Practice location:
  • Phone: 607-754-7117
  • Fax:
Mailing address:
  • Phone: 607-722-1918
  • Fax: 607-724-3865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR042064
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: