Active NPI
Keisha Moeller, BCBA
- Behavior Analyst
- Scranton, PA
National Provider Identifier
1104119247
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-11-9368
- Practice address
- 1509 Maple St
Scranton, PA 18505-2707 - Phone
- (818) 216-2764
- NPI assigned
- May 24, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | IMF66160 | CA | |
| Behavior Analyst | 103K00000X | 1-11-9368 | CA | Primary |
Addresses
Primary practice location
1509 Maple St
Scranton, PA 18505-2707
Mailing address
1509 Maple St
Scranton, PA 18505-2707
Phone (818) 216-2764
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IMF66160 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1306195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333411200000",
"number": "1104119247",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1509 MAPLE ST",
"city": "SCRANTON",
"state": "PA",
"postal_code": "185052707",
"telephone_number": "818-216-2764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1509 MAPLE ST",
"city": "SCRANTON",
"state": "PA",
"postal_code": "185052707",
"telephone_number": "818-216-2764"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOELLER",
"first_name": "KEISHA",
"name_prefix": "Mrs.",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-24",
"last_updated": "2012-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "IMF66160",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "1-11-9368",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Scranton, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.