Provider Demographics
NPI:1861371411
Name:ABARE, MOSES ASSIBI (LCSW)
Entity type:Individual
Prefix:
First Name:MOSES
Middle Name:ASSIBI
Last Name:ABARE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 EDGAR AVE APT A
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-3200
Mailing Address - Country:US
Mailing Address - Phone:570-594-9838
Mailing Address - Fax:570-594-9838
Practice Address - Street 1:502 EDGAR AVE APT A
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-3200
Practice Address - Country:US
Practice Address - Phone:570-594-9838
Practice Address - Fax:570-594-9838
Is Sole Proprietor?:No
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD31161104100000X
PACW0259161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker