Provider Demographics
NPI:1972656551
Name:MOSCOVITCH, BONNIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:
Last Name:MOSCOVITCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11755 POINTE PL
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4636
Mailing Address - Country:US
Mailing Address - Phone:404-246-7325
Mailing Address - Fax:770-664-8816
Practice Address - Street 1:11755 POINTE PL
Practice Address - Street 2:SUITE B-2
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4636
Practice Address - Country:US
Practice Address - Phone:404-246-7325
Practice Address - Fax:770-664-8816
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002776103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical