Healthcare Provider Details

I. General information

NPI: 1558518449
Provider Name (Legal Business Name): AMY M MOSKOVITZ L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 06/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8134 OLD KEENE MILL RD SUITE 101
SPRINGFIELD VA
22152-1800
US

IV. Provider business mailing address

8134 OLD KEENE MILL RD SUITE 101
SPRINGFIELD VA
22152-1800
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-8731
  • Fax: 703-569-7248
Mailing address:
  • Phone: 703-569-8731
  • Fax: 703-569-7248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004399
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: