MEDICARE: IRIS MOSAH

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	101YM0800X	Mental Health Counselor	39004581A	IN

General Provider Information

NPI Number	:	1184301053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRIS MOSAH

Provider Business Mailing Address
First Line	:	1300 VIRGINIA AVE APT 214
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15135-2053
Country	:	US
Telephone Number	:	901-463-9044
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 VIRGINIA AVE APT 214
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15135-2053
Country	:	US
Telephone Number	:	901-463-9044
Fax Number	:

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

Provider Enumeration Date	:	06/30/2023
Last Update Date	:	06/30/2023

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Directions to “ IRIS MOSAH ” Practice Location

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