Healthcare Provider Details

I. General information

NPI: 1457002925
Provider Name (Legal Business Name): LEO JANE MOSKOWITZ LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIANA MOSKOWITZ LICSW

II. Dates (important events)

Enumeration Date: 01/15/2022
Last Update Date: 02/11/2025
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 HUCKLEHILL RD
VERNON VT
05354-9592
US

IV. Provider business mailing address

235 HUCKLEHILL RD
VERNON VT
05354-9592
US

V. Phone/Fax

Practice location:
  • Phone: 516-639-4544
  • Fax:
Mailing address:
  • Phone: 516-639-4544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0134362
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: