Provider Demographics
NPI:1932458023
Name:MOAWAD, MARC SAMIR (MA)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:SAMIR
Last Name:MOAWAD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 CENTRAL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03235-2053
Mailing Address - Country:US
Mailing Address - Phone:603-934-1464
Mailing Address - Fax:603-935-2805
Practice Address - Street 1:841 CENTRAL ST STE 101
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NH
Practice Address - Zip Code:03235
Practice Address - Country:US
Practice Address - Phone:603-934-1464
Practice Address - Fax:603-935-2805
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YM0800X
NH222106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist