MEDICARE: STEPHEN D MOISOFF LCSW

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	34008757A	IN

General Provider Information

NPI Number	:	1487520854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN D MOISOFF LCSW

Provider Business Mailing Address
First Line	:	907 N EAST ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3425
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	907 N EAST ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3425
Country	:	US
Telephone Number	:	317-850-3873
Fax Number	:

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

Provider Enumeration Date	:	10/14/2025
Last Update Date	:	12/04/2025

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