Healthcare Provider Details

I. General information

NPI: 1003056177
Provider Name (Legal Business Name): DENISE MOYO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 WALTHAM ST
LEXINGTON MA
02421-8033
US

IV. Provider business mailing address

45 AUBURN ST
FRAMINGHAM MA
01701-4849
US

V. Phone/Fax

Practice location:
  • Phone: 781-761-5165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number215113
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-12-11628
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number215113
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: