MEDICARE: MISS MONICA COREE MOSES MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1033342126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MONICA COREE MOSES MSW

Provider Business Mailing Address
First Line	:	3901 RIDGE AVE
Second Line	:	APT 'A'
City	:	PHILA
State	:	PA
Zip	:	19132-1035
Country	:	US
Telephone Number	:	215-758-3651
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 RIDGE AVE
Second Line	:	APT 'A'
City	:	PHILA
State	:	PA
Zip	:	19132-1035
Country	:	US
Telephone Number	:	215-758-3651
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	08/24/2009

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