Provider Demographics
NPI:1396527073
Name:MOSS, CARTER
Entity type:Individual
Prefix:MR
First Name:CARTER
Middle Name:
Last Name:MOSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11891 NEELYTON RD
Mailing Address - Street 2:
Mailing Address - City:SHADE GAP
Mailing Address - State:PA
Mailing Address - Zip Code:17255-9247
Mailing Address - Country:US
Mailing Address - Phone:717-489-2949
Mailing Address - Fax:
Practice Address - Street 1:11891 NEELYTON RD
Practice Address - Street 2:
Practice Address - City:SHADE GAP
Practice Address - State:PA
Practice Address - Zip Code:17255-9247
Practice Address - Country:US
Practice Address - Phone:717-489-2949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker