Provider Demographics
NPI:1245589910
Name:MOSS, JOSEPHINE GIANNA (MS)
Entity Type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:GIANNA
Last Name:MOSS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12629 STEEPLECHASE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-3506
Mailing Address - Country:US
Mailing Address - Phone:904-878-1026
Mailing Address - Fax:904-212-5204
Practice Address - Street 1:12629 STEEPLECHASE LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-3506
Practice Address - Country:US
Practice Address - Phone:904-878-1026
Practice Address - Fax:904-212-5204
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2717251S00000X
FLMT 2717106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No251S00000XAgenciesCommunity/Behavioral Health