Provider Demographics
NPI:1598814238
Name:AUBREY, MOSS RICHARD (PHD)
Entity Type:Individual
Prefix:
First Name:MOSS
Middle Name:RICHARD
Last Name:AUBREY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 GOLD AVE SW
Mailing Address - Street 2:STE 202
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3300
Mailing Address - Country:US
Mailing Address - Phone:505-842-6968
Mailing Address - Fax:505-243-2776
Practice Address - Street 1:215 GOLD AVE SW
Practice Address - Street 2:STE 202
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3300
Practice Address - Country:US
Practice Address - Phone:505-842-6968
Practice Address - Fax:505-243-2776
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM488103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist