Provider Demographics
NPI:1609329523
Name:MOOSHEGIAN, EMILY (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MOOSHEGIAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 JUNCTION DR W
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-2931
Mailing Address - Country:US
Mailing Address - Phone:618-710-4123
Mailing Address - Fax:
Practice Address - Street 1:9 JUNCTION DR W
Practice Address - Street 2:SUITE 3
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-2931
Practice Address - Country:US
Practice Address - Phone:618-710-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149018665101Y00000X
MO2011024677101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor