Provider Demographics
NPI:1235108663
Name:MOSKOW, SHEREE (PHD)
Entity type:Individual
Prefix:MRS
First Name:SHEREE
Middle Name:
Last Name:MOSKOW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W COLLIN RAYE DR STE 103A
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-2000
Mailing Address - Country:US
Mailing Address - Phone:870-200-9294
Mailing Address - Fax:833-615-0500
Practice Address - Street 1:304 W COLLIN RAYE DR STE 103A
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-2000
Practice Address - Country:US
Practice Address - Phone:870-200-9294
Practice Address - Fax:833-615-0500
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA952103T00000X
ARAS-6P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y302Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO