Provider Demographics
NPI:1215070974
Name:MOY, SAMUEL (PHD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:MOY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 REXINGER LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2340
Mailing Address - Country:US
Mailing Address - Phone:860-704-6188
Mailing Address - Fax:
Practice Address - Street 1:7 REXINGER LN
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2340
Practice Address - Country:US
Practice Address - Phone:860-704-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1478103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist