Healthcare Provider Details

I. General information

NPI: 1205007127
Provider Name (Legal Business Name): PATRICIA A MOONEY PSY.D.H.S.P.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 NORTH CAMPBELL ROAD VALPARAISO
VALPARAISO IN
46385
US

IV. Provider business mailing address

4860 ROBB ST SUITE 201
WHEAT RIDGE CO
80033-2184
US

V. Phone/Fax

Practice location:
  • Phone: 219-462-1023
  • Fax:
Mailing address:
  • Phone: 303-278-7418
  • Fax: 888-341-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number20041185A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: