Provider Demographics
NPI:1972660983
Name:MOSER, MARY BARBARA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BARBARA
Last Name:MOSER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 WASHINGTON ST STE 203
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-6786
Mailing Address - Country:US
Mailing Address - Phone:812-372-7834
Mailing Address - Fax:
Practice Address - Street 1:404 WASHINGTON ST STE 203
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-6786
Practice Address - Country:US
Practice Address - Phone:812-372-7834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003249A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health