Healthcare Provider Details

I. General information

NPI: 1629522669
Provider Name (Legal Business Name): TATIANA MOQUETE M.ED, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 CAPITOL ST
METHUEN MA
01844-2831
US

IV. Provider business mailing address

35 CAPITOL ST
METHUEN MA
01844-2831
US

V. Phone/Fax

Practice location:
  • Phone: 978-590-2692
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10005174
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: