Provider Demographics
NPI:1578646089
Name:MOCCIA, RUTHIE (EDS)
Entity Type:Individual
Prefix:MS
First Name:RUTHIE
Middle Name:
Last Name:MOCCIA
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 FORUM BLVD
Mailing Address - Street 2:SUITE 3-A
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6322
Mailing Address - Country:US
Mailing Address - Phone:573-446-6290
Mailing Address - Fax:573-446-0618
Practice Address - Street 1:2804 FORUM BLVD
Practice Address - Street 2:SUITE 3-A
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6322
Practice Address - Country:US
Practice Address - Phone:573-446-6290
Practice Address - Fax:573-446-0618
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01054103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist