Provider Demographics
NPI:1447513528
Name:MOSHER, NANCY CARMELINA (MA, LPC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:CARMELINA
Last Name:MOSHER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2702
Mailing Address - Country:US
Mailing Address - Phone:203-389-5204
Mailing Address - Fax:203-787-1810
Practice Address - Street 1:1435 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2702
Practice Address - Country:US
Practice Address - Phone:203-389-5204
Practice Address - Fax:203-787-1810
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002210101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002210OtherL.P.C.