Provider Demographics
NPI:1134399819
Name:MOSKOFF, MARY PAULETTE (PHD LCSW)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:PAULETTE
Last Name:MOSKOFF
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:715 HILL ST
Mailing Address - Street 2:SUITE 200D
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3542
Mailing Address - Country:US
Mailing Address - Phone:608-238-5535
Mailing Address - Fax:608-238-7294
Practice Address - Street 1:715 HILL ST
Practice Address - Street 2:SUITE 200D
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3542
Practice Address - Country:US
Practice Address - Phone:608-238-5535
Practice Address - Fax:608-238-7294
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2274-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical