Provider Demographics
NPI:1477573608
Name:MOSS, STEVEN H (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:H
Last Name:MOSS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 E COLORADO BLVD
Mailing Address - Street 2:SUITE 802
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2039
Mailing Address - Country:US
Mailing Address - Phone:626-568-0022
Mailing Address - Fax:626-628-3465
Practice Address - Street 1:595 E COLORADO BLVD
Practice Address - Street 2:SUITE 802
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2039
Practice Address - Country:US
Practice Address - Phone:626-568-0022
Practice Address - Fax:626-628-3465
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16193103TH0100X, 103TR0400X, 103TA0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP16193Medicare ID - Type UnspecifiedMEDICARE