Provider Demographics
NPI:1124011853
Name:MOYNIHAN, BARBARA A (PHD, APRN,BC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:MOYNIHAN
Suffix:
Gender:F
Credentials:PHD, APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-0194
Mailing Address - Country:US
Mailing Address - Phone:888-616-8563
Mailing Address - Fax:203-481-4217
Practice Address - Street 1:1 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3872
Practice Address - Country:US
Practice Address - Phone:888-616-8563
Practice Address - Fax:203-481-4217
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT363LP0808X363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health