Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 215113 | MA |
N | 103K00000X | Behavior Analyst | 1-12-11628 | MA |
N | 1041C0700X | Clinical Social Worker | 215113 | MA |
NPI | 1003056177 |
---|---|
Provider Name | Denise Moyo |
First Address | Framingham, MA 01701-4849 |
Second Address | Lexington, MA 02421-8033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2009 |
Last Update Date | 09/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000023532 | BMC (01) | MA |
042611055 | TAX ID (01) | MA |
1004745 | NHP (01) | MA |
1303287 | (05) | MA |
1303287 | MBHP (01) | MA |
99618201 | NETWORKHEALTH (01) | MA |
M18633 | BCBS (01) | MA |