Provider Demographics
NPI:1235582230
Name:MOYER, ANDREW
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MOYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34-3 SHUNPIKE RD
Mailing Address - Street 2:#196
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34-3 SHUNPIKE RD
Practice Address - Street 2:#196
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2490
Practice Address - Country:US
Practice Address - Phone:860-604-6729
Practice Address - Fax:860-604-6729
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst