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General NPI Number Information
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NPI Number | 1639165780
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Entity Type | Individual
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Provider Name | BRENT ERIC MOOS MSW
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Gender | Male
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 110 CONNER DR STE 4
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City | CHAPEL HILL
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State | NC
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Zip | 27514-7044
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Country | US
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Telephone | 919-929-2311
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Fax |
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Provider Business Mailing Address
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Address Line | 3 TIMBERCREEK CT
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City | DURHAM
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State | NC
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Zip | 27712-9530
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Country | US
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Telephone | 919-477-8288
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P002840
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License Number State | NC
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