Provider Demographics
NPI:1194008441
Name:MOSES, MICHELLE R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:R
Last Name:MOSES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:45 NEILSON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2468
Mailing Address - Country:US
Mailing Address - Phone:831-728-0222
Mailing Address - Fax:831-707-2777
Practice Address - Street 1:195 AVIATION WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2053
Practice Address - Country:US
Practice Address - Phone:831-728-8250
Practice Address - Fax:831-707-2777
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA244111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical