Provider Demographics
NPI:1063769313
Name:BARRY MOILANEN, DONNA L (PHD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:BARRY MOILANEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:L
Other - Last Name:MOILANEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:89 MAIN ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1828
Mailing Address - Country:US
Mailing Address - Phone:508-244-0068
Mailing Address - Fax:
Practice Address - Street 1:89 MAIN ST
Practice Address - Street 2:SUITE 209
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1828
Practice Address - Country:US
Practice Address - Phone:508-244-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5034103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist