Provider Demographics
NPI:1144379561
Name:MOLDOVER, JOSEPH EMILE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:EMILE
Last Name:MOLDOVER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:555 WASHINGTON STREET
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-5996
Mailing Address - Country:US
Mailing Address - Phone:781-237-1735
Mailing Address - Fax:781-237-1768
Practice Address - Street 1:555 WASHINGTON STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-5996
Practice Address - Country:US
Practice Address - Phone:781-237-1735
Practice Address - Fax:781-237-1768
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA8256103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06378OtherBLUE CROSS PROVIDER NUMBE