Healthcare Provider Details

I. General information

NPI: 1730743097
Provider Name (Legal Business Name): LAUREN MOYE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 CONCORD AVE STE 102
CAMBRIDGE MA
02138-1173
US

IV. Provider business mailing address

545 CONCORD AVE STE 102
CAMBRIDGE MA
02138-1173
US

V. Phone/Fax

Practice location:
  • Phone: 617-684-5206
  • Fax:
Mailing address:
  • Phone: 617-684-5206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11821
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: