Provider Demographics
NPI:1205156510
Name:MOSS, SARAH RIMER (LCSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:RIMER
Last Name:MOSS
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 1:1300 KENYON ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-5636
Mailing Address - Country:US
Mailing Address - Phone:865-560-6008
Mailing Address - Fax:
Practice Address - Street 1:4639 NEWCOM AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5131
Practice Address - Country:US
Practice Address - Phone:865-769-6950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000051761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1520767Medicaid
TN1520767Medicaid