Provider Demographics
NPI:1003970179
Name:MOSS, SUSAN DOHR (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DOHR
Last Name:MOSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 9 1/2 STREET, N.E.
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902
Mailing Address - Country:US
Mailing Address - Phone:434-295-2222
Mailing Address - Fax:434-979-0410
Practice Address - Street 1:918 9 1/2 STREET, N.E.
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5311
Practice Address - Country:US
Practice Address - Phone:434-295-2222
Practice Address - Fax:434-979-0410
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001815103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA680000518Medicare Oscar/Certification