MEDICARE: DAVINA MOSS PH.D.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	17662	NY
2	251B00000X	Case Management Agency
3	101Y00000X	Counselor
4	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1568849339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVINA MOSS PH.D.

Provider Business Mailing Address
First Line	:	2690 SHERIDAN DRIVE
Second Line	:	FLOOR 1 SUITE 2
City	:	BUFFALO
State	:	NY
Zip	:	14150
Country	:	US
Telephone Number	:	716-704-5510
Fax Number	:	716-923-9455

Provider Business Practice Location Address
First Line	:	2690 SHERIDAN DR STE 1
Second Line	:
City	:	TONAWANDA
State	:	NY
Zip	:	14150-9425
Country	:	US
Telephone Number	:	716-704-5510
Fax Number	:	716-923-9455

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

Provider Enumeration Date	:	04/30/2015
Last Update Date	:	03/23/2026

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