Provider Demographics
NPI:1639165780
Name:MOOS, BRENT ERIC (MSW)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:ERIC
Last Name:MOOS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TIMBERCREEK CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-9530
Mailing Address - Country:US
Mailing Address - Phone:919-477-8288
Mailing Address - Fax:
Practice Address - Street 1:110 CONNER DR STE 4
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7044
Practice Address - Country:US
Practice Address - Phone:919-929-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0028401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical