Provider Demographics
NPI:1669613329
Name:MOSS, KATHERINE PAIGE (LISW, LCSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:PAIGE
Last Name:MOSS
Suffix:
Gender:F
Credentials:LISW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2266 1/2 E MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:BEXLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3910
Mailing Address - Country:US
Mailing Address - Phone:614-782-8262
Mailing Address - Fax:
Practice Address - Street 1:2266 1/2 E MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-3910
Practice Address - Country:US
Practice Address - Phone:614-782-8262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054491001041C0700X
NY0761571041C0700X
OHI.17003091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical