Provider Demographics
NPI:1932138054
Name:MOSELEY-WISS, ANNE (LICSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:MOSELEY-WISS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 3 PONDS RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-2008
Mailing Address - Country:US
Mailing Address - Phone:508-358-2264
Mailing Address - Fax:
Practice Address - Street 1:7 3 PONDS RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-2008
Practice Address - Country:US
Practice Address - Phone:508-859-4111
Practice Address - Fax:978-372-6736
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1056781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA62-00196OtherEVERCARE
MA62-00196OtherEVERCARE