Provider Demographics
NPI:1437668753
Name:MOYNAHAN, VANESSA LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:LEE
Last Name:MOYNAHAN
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:PSC 819 BOX 4386
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09645-0044
Mailing Address - Country:US
Mailing Address - Phone:360-490-0044
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL AMERICANO, BASE NAVAL DE ROTA
Practice Address - Street 2:APARTADO DE CORREOS 33
Practice Address - City:ROTA
Practice Address - State:CADIZ
Practice Address - Zip Code:11530
Practice Address - Country:ES
Practice Address - Phone:349-568-2330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
VA0810006575103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist