Provider Demographics
NPI:1033430889
Name:MOENCH, PAUL ARTHUR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ARTHUR
Last Name:MOENCH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 CARLETON ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1907
Mailing Address - Country:US
Mailing Address - Phone:510-529-5384
Mailing Address - Fax:
Practice Address - Street 1:1827 CARLETON ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-1907
Practice Address - Country:US
Practice Address - Phone:510-529-5384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 669103T00000X
ZZ90 03316103T00000X
CAPSY 18012103T00000X
CA18012103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist