Provider Demographics
NPI:1285313015
Name:STEFANIE MOYNIHAN, PH.D., LLC
Entity type:Organization
Organization Name:STEFANIE MOYNIHAN, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:ALISON MOYNIHAN
Authorized Official - Last Name:KYDES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-302-6086
Mailing Address - Street 1:220 BOWEN CT STE A
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1945
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 BOWEN CT STE A
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1945
Practice Address - Country:US
Practice Address - Phone:617-302-6086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty