Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 7771 | MA |
N | 103TC0700X | Clinical Psychologist | 7771 | MA |
N | 103TH0100X | Health Service | 7771 | MA |
NPI | 1104906114 |
---|---|
Provider Name | Dr. H Suzanne Moon |
First Address | Weymouth, MA 02189-3101 |
Second Address | Weymouth, MA 02189-3101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0502197 | (05) | MA |
A866565 | VALUE OPTIONS PROVIDER NU (01) | MD |
W06212 | BCBS PROVIDER NUMBER (01) | MA |