Provider Demographics
NPI:1184241671
Name:LIVICK-MOSES, JOHN THOMAS (LICSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:LIVICK-MOSES
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2274 PINNACLE CT
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-6439
Mailing Address - Country:US
Mailing Address - Phone:540-290-7176
Mailing Address - Fax:
Practice Address - Street 1:1261 FURNACE BROOK PKWY STE 31
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4768
Practice Address - Country:US
Practice Address - Phone:617-479-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1265521041C0700X
MA0002258921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical