Provider Demographics
NPI:1255678959
Name:MOSHIER, KEVIN J (LCSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:MOSHIER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 WESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-2723
Mailing Address - Country:US
Mailing Address - Phone:203-751-7685
Mailing Address - Fax:
Practice Address - Street 1:51 SHERMAN HILL RD
Practice Address - Street 2:BUILDING A, SUITE 104C
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3648
Practice Address - Country:US
Practice Address - Phone:203-751-7685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0079891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical