Provider Demographics
NPI:1144666744
Name:MOSES, MICHAEL TROY (LCSW108940)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TROY
Last Name:MOSES
Suffix:
Gender:M
Credentials:LCSW108940
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 BACON ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2021
Mailing Address - Country:US
Mailing Address - Phone:678-577-1165
Mailing Address - Fax:
Practice Address - Street 1:2245 BACON ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2021
Practice Address - Country:US
Practice Address - Phone:678-577-1165
Practice Address - Fax:925-680-7987
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA972931041C0700X
CALCSW1089401041C0700X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst