Provider Demographics
NPI:1336291962
Name:MOSCOU, PATRICIA JO (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:JO
Last Name:MOSCOU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 CENTRAL PARK W APT 1E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3035
Mailing Address - Country:US
Mailing Address - Phone:917-847-7052
Mailing Address - Fax:
Practice Address - Street 1:275 CENTRAL PARK W APT 1E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3035
Practice Address - Country:US
Practice Address - Phone:917-847-7052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7629103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV55351Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST