Healthcare Provider Details

I. General information

NPI: 1558226712
Provider Name (Legal Business Name): MOSS MIRROR LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 QUEEN ANNE LN
WAPPINGERS FALLS NY
12590-6013
US

IV. Provider business mailing address

51 QUEEN ANNE LN
WAPPINGERS FALLS NY
12590-6013
US

V. Phone/Fax

Practice location:
  • Phone: 607-437-3158
  • Fax:
Mailing address:
  • Phone: 607-437-3158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MICHAELA MURPHY
Title or Position: MANAGING MEMBER
Credential: LCSW
Phone: 631-485-6507