Provider Demographics
NPI:1184647562
Name:MOSKOWITZ, KENNETH (LCSW)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:MOSKOWITZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 RUE BIENVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044
Mailing Address - Country:US
Mailing Address - Phone:954-907-0383
Mailing Address - Fax:
Practice Address - Street 1:5851 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146
Practice Address - Country:US
Practice Address - Phone:702-732-0304
Practice Address - Fax:702-794-2033
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW27961041C0700X
NV10684C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6384ZMedicare PIN