MEDICARE: MR. LEWIS JAY MOSKOWITZ LMHC

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	MH2677	FL

General Provider Information

NPI Number	:	1538172911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEWIS JAY MOSKOWITZ LMHC

Provider Business Mailing Address
First Line	:	128 OYSTER BAY WAY
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-0514
Country	:	US
Telephone Number	:	904-770-9717
Fax Number	:	904-217-0900

Provider Business Practice Location Address
First Line	:	6000A SAWGRASS VILLAGE CIR STE 6
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-5061
Country	:	US
Telephone Number	:	904-770-9717
Fax Number	:	904-217-0900

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	12/20/2019

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