Provider Demographics
NPI:1679798771
Name:MOSE, CHANDRICKA RENEE (MSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:CHANDRICKA
Middle Name:RENEE
Last Name:MOSE
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12210 AMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3111
Mailing Address - Country:US
Mailing Address - Phone:301-776-9554
Mailing Address - Fax:
Practice Address - Street 1:12210 AMBLEWOOD DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3111
Practice Address - Country:US
Practice Address - Phone:301-776-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD099961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical