Healthcare Provider Details

I. General information

NPI: 1336540509
Provider Name (Legal Business Name): LAURA ELIZABETH MOYA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 ONECO ST STE 2
NORWICH CT
06360-3440
US

IV. Provider business mailing address

22 LYNN DR
LEDYARD CT
06339-1311
US

V. Phone/Fax

Practice location:
  • Phone: 860-326-4474
  • Fax:
Mailing address:
  • Phone: 860-326-4474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1971
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: