Provider Demographics
NPI:1235933458
Name:MOSSE, AMY RACHEL
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RACHEL
Last Name:MOSSE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 OLD KEYSTONE RD
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-7849
Mailing Address - Country:US
Mailing Address - Phone:727-942-4181
Mailing Address - Fax:
Practice Address - Street 1:3575 OLD KEYSTONE RD
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688-7807
Practice Address - Country:US
Practice Address - Phone:727-942-4181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health