Healthcare Provider Details

I. General information

NPI: 1407366941
Provider Name (Legal Business Name): CAITLIN ANN MOYA MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1167 MANTUA PIKE
WEST DEPTFORD NJ
08051-1649
US

IV. Provider business mailing address

206 STONE RD
LAUREL SPRINGS NJ
08021-2142
US

V. Phone/Fax

Practice location:
  • Phone: 419-262-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: