Provider Demographics
NPI:1992438287
Name:REZNITSKY, MOSHE
Entity type:Individual
Prefix:
First Name:MOSHE
Middle Name:
Last Name:REZNITSKY
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 1:2421 LIGHTFOOT DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1545
Mailing Address - Country:US
Mailing Address - Phone:305-904-0228
Mailing Address - Fax:
Practice Address - Street 1:2421 LIGHTFOOT DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-1545
Practice Address - Country:US
Practice Address - Phone:305-904-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19302101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health