Provider Demographics
NPI:1023287968
Name:MOLESWORTH, J. ROBERT (MSW)
Entity type:Individual
Prefix:MR
First Name:J.
Middle Name:ROBERT
Last Name:MOLESWORTH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 NE COURT ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1935
Mailing Address - Country:US
Mailing Address - Phone:541-447-7441
Mailing Address - Fax:541-447-6694
Practice Address - Street 1:203 NE COURT ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1935
Practice Address - Country:US
Practice Address - Phone:541-447-7441
Practice Address - Fax:541-447-6694
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health