Provider Demographics
NPI:1760595441
Name:MOSCOW, SHERWIN H (MA)
Entity Type:Individual
Prefix:MR
First Name:SHERWIN
Middle Name:H
Last Name:MOSCOW
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5264 NE 121ST AVE APT 315
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-2160
Mailing Address - Country:US
Mailing Address - Phone:360-828-5844
Mailing Address - Fax:
Practice Address - Street 1:1550 NW EASTMAN PKWY
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3858
Practice Address - Country:US
Practice Address - Phone:503-571-0725
Practice Address - Fax:503-571-0720
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR88-09-01101YA0400X
WACP00005723101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)