Most Relevant Information
Provider Data
| NPI Number: | 1003317108 |
| Provider Name: | PENNY MOSHER MSW INTERN |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/23/2018 |
| Last Updated: | 02/23/2018 |
Provider Practice Location
167 POLK ST STE 300
WATERTOWN
NY
136012770
Practice Location Phone/Fax
| Phone: | 3157827445 |
| Fax: | 3157791184 |
Provider Mailing Location
PO BOX 6550
WATERTOWN
NY
136016550
Provider Mailing Phone/Fax
| Phone: | 3157827445 |
| Fax: | 3157791184 |