Provider Demographics
NPI:1649670167
Name:NEIL L. MOSER, LCSW,LLC
Entity type:Organization
Organization Name:NEIL L. MOSER, LCSW,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-580-1807
Mailing Address - Street 1:16 WALNUT AVE SW
Mailing Address - Street 2:16 WALNUT AVENUE
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4719
Mailing Address - Country:US
Mailing Address - Phone:540-580-1807
Mailing Address - Fax:
Practice Address - Street 1:16 WALNUT AVE SW
Practice Address - Street 2:16 WALNUT AVENUE
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4719
Practice Address - Country:US
Practice Address - Phone:540-580-1807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040068251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA102982OtherMEDICARE PTAN