Provider Demographics
NPI:1124276605
Name:CREEDON, MOIRA ANNE (PHD)
Entity type:Individual
Prefix:
First Name:MOIRA
Middle Name:ANNE
Last Name:CREEDON
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 1:1900 W PARK DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3942
Mailing Address - Country:US
Mailing Address - Phone:617-359-2166
Mailing Address - Fax:
Practice Address - Street 1:1900 W PARK DR
Practice Address - Street 2:SUITE 280
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3942
Practice Address - Country:US
Practice Address - Phone:617-359-2166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent