Provider Demographics
NPI:1598239865
Name:NASH, MOISE JAMEL
Entity Type:Individual
Prefix:
First Name:MOISE
Middle Name:JAMEL
Last Name:NASH
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 1:1039 S PARKER RD APT N18
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2587
Mailing Address - Country:US
Mailing Address - Phone:718-503-8768
Mailing Address - Fax:
Practice Address - Street 1:1039 S PARKER RD APT N18
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2587
Practice Address - Country:US
Practice Address - Phone:718-503-8768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO682104100000X
CO104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker