Provider Demographics
NPI:1508124058
Name:MOSKOWITZ, JENNIE M (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:M
Last Name:MOSKOWITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:M
Other - Last Name:LOBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 US ROUTE 1 UNIT 153
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8127
Mailing Address - Country:US
Mailing Address - Phone:207-307-0757
Mailing Address - Fax:
Practice Address - Street 1:201 US ROUTE 1 UNIT 153
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8127
Practice Address - Country:US
Practice Address - Phone:207-307-0757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW022201041C0700X
NH29761041C0700X
MELC140331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical