Provider Demographics
NPI:1497926646
Name:MOSHER, ROBERT DALE
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DALE
Last Name:MOSHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42242
Mailing Address - Street 2:
Mailing Address - City:BROOK PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-0242
Mailing Address - Country:US
Mailing Address - Phone:440-886-1396
Mailing Address - Fax:440-886-1409
Practice Address - Street 1:6160 STUMPH RD
Practice Address - Street 2:#105
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-1886
Practice Address - Country:US
Practice Address - Phone:440-292-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor