Provider Demographics
NPI:1235108663
Name:MOSKOW, SHEREE (PHD)
Entity Type:Individual
Prefix:MRS
First Name:SHEREE
Middle Name:
Last Name:MOSKOW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 ARKANSAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-2536
Mailing Address - Country:US
Mailing Address - Phone:870-773-4622
Mailing Address - Fax:870-772-4650
Practice Address - Street 1:1312 W COLLIN RAYE DR
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-2135
Practice Address - Country:US
Practice Address - Phone:870-584-7115
Practice Address - Fax:870-642-3388
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAS-6P103T00000X
LA952103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y302Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO