Healthcare Provider Details

I. General information

NPI: 1104906114
Provider Name (Legal Business Name): H SUZANNE MOON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 LIBBEY INDUSTRIAL PKWY 2ND FLOOR
WEYMOUTH MA
02189-3101
US

IV. Provider business mailing address

169 LIBBEY INDUSTRIAL PKWY 2ND FLOOR
WEYMOUTH MA
02189-3101
US

V. Phone/Fax

Practice location:
  • Phone: 781-682-1060
  • Fax: 781-682-1061
Mailing address:
  • Phone: 781-682-1060
  • Fax: 781-682-1061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7771
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number7771
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: