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General NPI Number Information
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NPI Number | 1366505828
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Entity Type | Individual
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Provider Name | LELAND DARRELL MOSBY ED.D.
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 102 BROWNING LN BLDG C, SUITE 5
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City | CHERRY HILL
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State | NJ
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Zip | 08003-3195
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Country | US
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Telephone | 856-857-0881
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Fax |
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Provider Business Mailing Address
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Address Line | 102 BROWNING LN BLDG C, SUITE 5
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City | CHERRY HILL
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State | NJ
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Zip | 08003-3195
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Country | US
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Telephone | 856-857-0881
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PC-0000555
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | SI3313
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | SI3313
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License Number State | NJ
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