Healthcare Provider Details

I. General information

NPI: 1477911212
Provider Name (Legal Business Name): CYNTHIA MOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6475 NEW HAMPSHIRE AVE 610
HYATTSVILLE MD
20783-3269
US

IV. Provider business mailing address

3406 GATESHEAD MANOR WAY 301
SILVER SPRING MD
20904-6112
US

V. Phone/Fax

Practice location:
  • Phone: 301-270-3200
  • Fax:
Mailing address:
  • Phone: 202-368-5677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21066
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: