Provider Demographics
NPI:1871332650
Name:MOSER, DENISE LORI
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:LORI
Last Name:MOSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E LANCASTER AVE APT B201
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2025
Mailing Address - Country:US
Mailing Address - Phone:610-662-6066
Mailing Address - Fax:
Practice Address - Street 1:625 E LANCASTER AVE APT B201
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2025
Practice Address - Country:US
Practice Address - Phone:610-662-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health