Provider Demographics
NPI:1992779011
Name:MOITOSO, PAUL (MSW, BCD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:MOITOSO
Suffix:
Gender:M
Credentials:MSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 BELMONT ST
Mailing Address - Street 2:(122 - BLDG 3, A-504A)
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5596
Mailing Address - Country:US
Mailing Address - Phone:719-325-6419
Mailing Address - Fax:774-826-2631
Practice Address - Street 1:940 BELMONT ST
Practice Address - Street 2:122 - BLDG 3, A-504A
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5596
Practice Address - Country:US
Practice Address - Phone:774-826-2769
Practice Address - Fax:774-826-2631
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10313371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical