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General NPI Number Information
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NPI Number | 1205806981
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Entity Type | Individual
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Provider Name | KEITH CORY MOSS PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 1808 DEL WEBB GARDENS DR
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-3359
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Country | US
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Telephone | 631-271-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 1808 DEL WEBB GARDENS DR
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-3359
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Country | US
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Telephone | 631-271-8800
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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 | 8629
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License Number State | NY
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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 | 8629
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 8629
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 8629
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number | 8629
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 8629
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License Number State | NY
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Taxonomy #7
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 008629
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License Number State | NY
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Taxonomy #8
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PP6551
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License Number State | NC
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Taxonomy #9
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | TPPY2772
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License Number State | FL
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Taxonomy #10
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 8629
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License Number State | NY
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Taxonomy #11
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 8629
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License Number State | NY
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Taxonomy #12
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | 8629
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License Number State | NY
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Taxonomy #13
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 8629
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License Number State | NY
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