Provider Demographics
NPI:1851680755
Name:MOSER, TERESA MARIE (LMSW)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:MARIE
Last Name:MOSER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1387 E M 89
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MI
Mailing Address - Zip Code:49078-9301
Mailing Address - Country:US
Mailing Address - Phone:269-692-2100
Mailing Address - Fax:
Practice Address - Street 1:1387 E M 89
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MI
Practice Address - Zip Code:49078-9301
Practice Address - Country:US
Practice Address - Phone:269-692-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010879031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical