Provider Demographics
NPI:1538606512
Name:MOSBY, CORNELIUS
Entity type:Individual
Prefix:
First Name:CORNELIUS
Middle Name:
Last Name:MOSBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2731 SHOWPLACE DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-3324
Mailing Address - Country:US
Mailing Address - Phone:773-663-7273
Mailing Address - Fax:
Practice Address - Street 1:2731 SHOWPLACE DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-3324
Practice Address - Country:US
Practice Address - Phone:773-663-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker