Rose Renee Moten, PHD, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301011845 Issued in MI

Practice address

5555 Conner St
Suite 3055
Detroit, MI 48213-3448

Phone

(313) 717-7673

Fax

(313) 557-5317

NPI assigned

Oct 18, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Rose Moten Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Henry Ford Health Eastwood Behavioral Health

  • Social Worker
  • Clinton Township, MI
  • NPI 1396787701
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465776000000",
    "number": "1225119613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7234 WOODLORE DR",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483231388",
            "telephone_number": "313-717-7673",
            "fax_number": "313-557-5317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 CONNER ST",
            "address_2": "SUITE 3055",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482133448",
            "telephone_number": "313-717-7673",
            "fax_number": "313-557-5317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOTEN",
        "first_name": "ROSE",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "PHD, LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2016-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301011845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROSE",
            "last_name": "MOTEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Taylor Moss
• Feras Mossa-Basha
• Sara Mossa-Basha, PHARMD
• Usamah Mossallam, MD
• Leticia Mota
• Mother of Faith Home Help Care
• Mother of Four Helping Hands LLC
• Motivational Family & Friends Circle
• Wilda Motley-Penn, MA, LLPC
• Andrea D Motley, LLMSW

• Psychologist in Detroit, MI
• Providers in Detroit, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.