Provider Demographics
NPI:1063746907
Name:MOSKOWITZ, JEFF
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:MOSKOWITZ
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 1:2540 MADISON RD APT 12
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1124
Mailing Address - Country:US
Mailing Address - Phone:513-321-3468
Mailing Address - Fax:
Practice Address - Street 1:999 LILA AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1617
Practice Address - Country:US
Practice Address - Phone:513-831-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0001374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health