Provider Demographics
NPI:1457002925
Name:MOSKOWITZ, LEO JANE (LICSW)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:JANE
Last Name:MOSKOWITZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LIANA
Other - Middle Name:
Other - Last Name:MOSKOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:235 HUCKLEHILL RD
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:VT
Mailing Address - Zip Code:05354-9592
Mailing Address - Country:US
Mailing Address - Phone:516-639-4544
Mailing Address - Fax:
Practice Address - Street 1:235 HUCKLEHILL RD
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:VT
Practice Address - Zip Code:05354-9592
Practice Address - Country:US
Practice Address - Phone:516-639-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-15
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01343621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical