=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730421801
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERRI L MOSER PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2013
-----------------------------------------------------
Last Update Date | 09/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 BEE ST
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29401-5703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-308-3871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 224 URBANO LN
-----------------------------------------------------
City | GOOSE CREEK
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29445-3671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-524-9586
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 020000
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------