Doctor Name: | PATRICIA MARY JEAN MOSBACHER |
NPI Number: | 1164715918 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.C.S.W. |
License Number: | 2011003368 |
Business Practice Address: | 125 N Ruby Ln Fairview Heights, IL - 622081926 |
Business Phone Number: | 6183984226 |
Business Fax Number: | |
Mailing Address: | 509 Grand Ave, WATERLOO |
State: | IL |
Postal Code: | 622981129 |
Phone Number: | 6188308878 |
Fax Number: | |
NPI Enumeration Date: | 05/25/2011 |
NPI Last Update Date: | 11/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 2011003368 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |