Provider Demographics
NPI:1669818159
Name:KEN MOSKOWITZ PA
Entity Type:Organization
Organization Name:KEN MOSKOWITZ PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-907-0383
Mailing Address - Street 1:366 NW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7921
Mailing Address - Country:US
Mailing Address - Phone:954-907-0383
Mailing Address - Fax:954-797-4911
Practice Address - Street 1:7500 NW 5TH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1612
Practice Address - Country:US
Practice Address - Phone:954-584-6478
Practice Address - Fax:954-797-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-11
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW27961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty