Provider Demographics
NPI:1346077583
Name:MOSES-AVILA, ROSMOND
Entity type:Individual
Prefix:
First Name:ROSMOND
Middle Name:
Last Name:MOSES-AVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16020 65TH STREET CT E APT F
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-3056
Mailing Address - Country:US
Mailing Address - Phone:646-919-7445
Mailing Address - Fax:
Practice Address - Street 1:6201 PACIFIC AVE STE C3
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7423
Practice Address - Country:US
Practice Address - Phone:253-363-8853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61477728101Y00000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical