Provider Demographics
NPI:1962244210
Name:MOESLEIN, MARIA (LBS)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MOESLEIN
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 SANDY DR STE D
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2205
Mailing Address - Country:US
Mailing Address - Phone:814-380-9180
Mailing Address - Fax:
Practice Address - Street 1:2160 SANDY DR STE D
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2205
Practice Address - Country:US
Practice Address - Phone:814-380-9180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH007156103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst