Provider Demographics
NPI:1215004460
Name:MOSS-OSWALT, BEVERLY J (MSW)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:J
Last Name:MOSS-OSWALT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 4 BOX 636
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-9685
Mailing Address - Country:US
Mailing Address - Phone:814-942-6245
Mailing Address - Fax:
Practice Address - Street 1:208 LAKEMONT PARK BOULEVARD
Practice Address - Street 2:HNA EARLY INTERVENTION
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602
Practice Address - Country:US
Practice Address - Phone:814-944-8177
Practice Address - Fax:814-944-7413
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001866771003Medicaid