Provider Demographics
NPI:1235276767
Name:MOSHER, CHRISTINE MICHELE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MICHELE
Last Name:MOSHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MILLER CT
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1517
Mailing Address - Country:US
Mailing Address - Phone:631-331-1199
Mailing Address - Fax:
Practice Address - Street 1:2 MILLER CT
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-1517
Practice Address - Country:US
Practice Address - Phone:631-331-1199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0267621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical