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General NPI Number Information
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NPI Number | 1093719544
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Entity Type | Individual
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Provider Name | MOIRA A HUBBARD PSY. D.
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Gender | Female
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Dates
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Enumeration Date | 06/10/2005
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Last Update Date | 02/03/2011
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Provider Practice Location Address
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Address Line | 2395 OAK VALLEY DR SUITE 100
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City | ANN ARBOR
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State | MI
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Zip | 48103-8943
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Country | US
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Telephone | 734-995-5181
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Fax | 734-995-9011
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Provider Business Mailing Address
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Address Line | 2395 OAK VALLEY DR SUITE 100
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City | ANN ARBOR
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State | MI
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Zip | 48103-8943
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Country | US
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Telephone | 734-995-5181
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Fax | 734-995-9011
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 63001008483
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 22353
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License Number State | CA
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