Provider Demographics
NPI:1346867033
Name:MOSER, CASEY JANNAE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:JANNAE
Last Name:MOSER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 BLUESTONE PL
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-4147
Mailing Address - Country:US
Mailing Address - Phone:407-920-2584
Mailing Address - Fax:
Practice Address - Street 1:734 IRMA AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3853
Practice Address - Country:US
Practice Address - Phone:407-920-2584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7405103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical