Provider Demographics
NPI:1316480098
Name:SHAW-MOSS, CAROLINE AMINA (LCAT,ATR)
Entity type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:AMINA
Last Name:SHAW-MOSS
Suffix:
Gender:F
Credentials:LCAT,ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1996
Mailing Address - Country:US
Mailing Address - Phone:516-778-6791
Mailing Address - Fax:
Practice Address - Street 1:101 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-1996
Practice Address - Country:US
Practice Address - Phone:516-778-6791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health