Provider Demographics
NPI:1609324250
Name:MOSES, MOLLY ELDER (LICSW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ELDER
Last Name:MOSES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 GOTHIC ST # 2
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3047
Mailing Address - Country:US
Mailing Address - Phone:413-345-2571
Mailing Address - Fax:413-825-0318
Practice Address - Street 1:53 GOTHIC ST # 2
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3047
Practice Address - Country:US
Practice Address - Phone:413-345-2571
Practice Address - Fax:413-825-0318
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0001234601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110172915AMedicaid