Healthcare Provider Details

I. General information

NPI: 1588827679
Provider Name (Legal Business Name): PROFESSIONAL PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 D SAPPHIRE BAY W
ST THOMAS VI
00802
US

IV. Provider business mailing address

31 D SAPPHIRE BAY W
ST THOMAS VI
00802
US

V. Phone/Fax

Practice location:
  • Phone: 340-775-1103
  • Fax:
Mailing address:
  • Phone: 340-775-1103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number98006PSY
License Number StateVI

VIII. Authorized Official

Name: DR. RAMONA MOSS
Title or Position: PRESIDENT
Credential: PHD
Phone: 340-775-1103