Provider Demographics
NPI:1558518449
Name:MOSKOVITZ, AMY M (LPC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:M
Last Name:MOSKOVITZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8134 OLD KEENE MILL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1800
Mailing Address - Country:US
Mailing Address - Phone:703-569-8731
Mailing Address - Fax:703-569-7248
Practice Address - Street 1:8134 OLD KEENE MILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1800
Practice Address - Country:US
Practice Address - Phone:703-569-8731
Practice Address - Fax:703-569-7248
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004399101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1558518449Medicaid