Provider Demographics
NPI:1619151081
Name:MOSHKOVITCH, INGA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:INGA
Middle Name:
Last Name:MOSHKOVITCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 62ND ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1246
Mailing Address - Country:US
Mailing Address - Phone:650-520-3411
Mailing Address - Fax:510-808-4097
Practice Address - Street 1:599 62ND ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1246
Practice Address - Country:US
Practice Address - Phone:650-520-3411
Practice Address - Fax:510-808-4097
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21793103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist