Provider Demographics
NPI:1053493213
Name:MOSKOWITZ, JONINA L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JONINA
Middle Name:L
Last Name:MOSKOWITZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 INDEPENDENCE BLVD
Mailing Address - Street 2:PEMBROKE SIX, STE. 212
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-2911
Mailing Address - Country:US
Mailing Address - Phone:757-285-0640
Mailing Address - Fax:757-473-2104
Practice Address - Street 1:297 INDEPENDENCE BLVD
Practice Address - Street 2:PEMBROKE SIX, STE. 212
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2911
Practice Address - Country:US
Practice Address - Phone:757-285-0640
Practice Address - Fax:757-473-2104
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002586103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1053493213Medicaid
1053493212OtherOPTIMA BEHAVIORAL HEALTH
460005OtherMANAGED HEALTH NETWORK