Provider Demographics
NPI:1043425051
Name:MOYLAN, PAULA (LCPC PA)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:MOYLAN
Suffix:
Gender:F
Credentials:LCPC PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16909 DAISY DELL CT
Mailing Address - Street 2:
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-1036
Mailing Address - Country:US
Mailing Address - Phone:410-329-6961
Mailing Address - Fax:410-298-8225
Practice Address - Street 1:1001 CROMWELL BRIDGE RD
Practice Address - Street 2:SUITE 308
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-3300
Practice Address - Country:US
Practice Address - Phone:410-298-8223
Practice Address - Fax:410-298-8225
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1230101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS949J648Medicare PIN