Provider Demographics
NPI:1285837831
Name:MOOS, ALAN (MSW LCSW LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:MOOS
Suffix:
Gender:M
Credentials:MSW LCSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 JOHNSON PASTURE DR
Mailing Address - Street 2:
Mailing Address - City:GAILFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05301-8376
Mailing Address - Country:US
Mailing Address - Phone:802-257-2665
Mailing Address - Fax:
Practice Address - Street 1:111 JOHNSON PASTURE DR
Practice Address - Street 2:
Practice Address - City:GAILFORD
Practice Address - State:VT
Practice Address - Zip Code:05301-8376
Practice Address - Country:US
Practice Address - Phone:802-257-2665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0890000572LICSW1041C0700X
NJ44SC00755800LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012310Medicaid
VT00029192OtherBCBS OF VT