Healthcare Provider Details

I. General information

NPI: 1437668753
Provider Name (Legal Business Name): VANESSA LEE MOYNAHAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL AMERICANO, BASE NAVAL DE ROTA APARTADO DE CORREOS 33
ROTA CADIZ
11530
ES

IV. Provider business mailing address

PSC 819 BOX 4386
FPO AE
09645-0044
US

V. Phone/Fax

Practice location:
  • Phone: 349-568-2330
  • Fax:
Mailing address:
  • Phone: 360-490-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810006575
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: