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General NPI Number Information
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NPI Number | 1972687440
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Entity Type | Individual
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Provider Name | ELISABETH MOES PH.D., ABPP/ABCN
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Gender | Female
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 1180 BEACON ST SUITE 2D
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City | BROOKLINE
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State | MA
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Zip | 02446-3885
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Country | US
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Telephone | 617-232-6305
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Fax | 617-739-7111
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Provider Business Mailing Address
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Address Line | 280 CHESTNUT AVE
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-4414
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Country | US
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Telephone | 617-522-7061
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Fax | 617-739-7111
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 3569
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License Number State | MA
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