Provider Demographics
NPI:1164715918
Name:MOSBACHER, PATRICIA MARY JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARY JEAN
Last Name:MOSBACHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:MARY JEAN
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-0151
Mailing Address - Country:US
Mailing Address - Phone:618-830-8878
Mailing Address - Fax:
Practice Address - Street 1:220 BRADFORD LN STE C
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-3370
Practice Address - Country:US
Practice Address - Phone:618-939-3919
Practice Address - Fax:618-939-3920
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110033681041C0700X
IL1490021181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical