Healthcare Provider Details

I. General information

NPI: 1194092270
Provider Name (Legal Business Name): LIZBETH ANNE MOSES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8403 WHITMAN DR
BETHESDA MD
20817-6822
US

IV. Provider business mailing address

8403 WHITMAN DR
BETHESDA MD
20817-6822
US

V. Phone/Fax

Practice location:
  • Phone: 301-767-9842
  • Fax:
Mailing address:
  • Phone: 301-767-9842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number03007
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number03007
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: