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General NPI Number Information
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NPI Number | 1154137933
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Entity Type | Individual
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Provider Name | ELIZABETH RUTH-ANNE MOULTON PSY.S
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Gender | Female
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 21300 RUTH AND BARON COLEMAN BLVD
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City | BOCA RATON
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State | FL
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Zip | 33428-1757
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Country | US
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Telephone | 561-852-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 3333 N FEDERAL HWY APT 415
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City | OAKLAND PARK
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State | FL
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Zip | 33306-1086
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Country | US
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Telephone | 419-340-8569
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Fax |
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | SS1924
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License Number State | FL
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