Provider Demographics
NPI:1609950286
Name:MOYER, DAVID (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MOYER
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 1:200 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3581
Mailing Address - Country:US
Mailing Address - Phone:860-646-9660
Mailing Address - Fax:860-643-4074
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-3581
Practice Address - Country:US
Practice Address - Phone:860-646-9660
Practice Address - Fax:860-643-4074
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00858103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT82742OtherCIGNA
CT004009114Medicaid
CT060000858CT01OtherANTHEM
CT066401OtherVALUE OPTIONS
CT189527OtherMHN
CTP765675OtherOXFORD
CT4210626OtherAETNA
CT4210626OtherAETNA