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General NPI Number Information
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NPI Number | 1639678709
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Entity Type | Organization
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Legal Business Name | JOSEPH MOLDOVER, PC
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Dates
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Enumeration Date | 02/05/2018
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Last Update Date | 02/05/2018
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Provider Practice Location Address
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Address Line | 555 WASHINGTON ST STE 5
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City | WELLESLEY
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State | MA
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Zip | 02482-5946
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Country | US
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Telephone | 781-237-1735
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Fax | 781-237-1768
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Provider Business Mailing Address
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Address Line | 555 WASHINGTON ST STE 5
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City | WELLESLEY
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State | MA
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Zip | 02482-5946
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Country | US
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Telephone | 781-237-1735
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Fax | 781-237-1768
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH MOLDOVER
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Credential | PSYD
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Telephone | 781-237-1735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 8256
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License Number State | MA
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