Provider Demographics
NPI:1477701191
Name:MOSS, CARL (MS LMHC)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:
Last Name:MOSS
Suffix:
Gender:M
Credentials:MS LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 CAMINO GARDENS BLVD
Mailing Address - Street 2:#202
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5827
Mailing Address - Country:US
Mailing Address - Phone:561-347-6772
Mailing Address - Fax:561-417-9174
Practice Address - Street 1:398 CAMINO GARDENS BLVD
Practice Address - Street 2:#202
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5827
Practice Address - Country:US
Practice Address - Phone:561-347-6772
Practice Address - Fax:561-417-9174
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4807101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health