Healthcare Provider Details

I. General information

NPI: 1992175624
Provider Name (Legal Business Name): RUTENDO FAITH MOYO LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MERRILL LN APT 4
DRACUT MA
01826-4451
US

IV. Provider business mailing address

500 MERRILL LN APT 4
DRACUT MA
01826-4451
US

V. Phone/Fax

Practice location:
  • Phone: 207-313-1675
  • Fax:
Mailing address:
  • Phone: 207-313-1675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119257
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: