MEDICARE: STEPHEN ANDREW MOSKOP

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	:	1215668504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN ANDREW MOSKOP

Provider Business Mailing Address
First Line	:	2377 N 73RD ST
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-1209
Country	:	US
Telephone Number	:	773-405-1624
Fax Number	:

Provider Business Practice Location Address
First Line	:	2377 N 73RD ST
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-1209
Country	:	US
Telephone Number	:	773-405-1624
Fax Number	:

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

Provider Enumeration Date	:	06/18/2022
Last Update Date	:	01/07/2026

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