Individual provider Active NPI

Olivia Ann Moquin, MS, LLP

  • Psychologist
  • Dearborn, MI
National Provider Identifier
1447880463
Registry record updated Jun 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6361007867 Issued in MI
Practice address
835 Mason St Ste B220
Dearborn, MI 48124-2262
Phone
(313) 561-9064
NPI assigned
Jan 17, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6361007867 MI Primary

Addresses

Primary practice location

835 Mason St Ste B220
Dearborn, MI 48124-2262

Mailing address

835 Mason St Ste B220
Dearborn, MI 48124-2262
Phone (313) 561-9064

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Master of Science - Law

Practice roles

OrganizationSpecialtyStatusNew patients
Michigan Modern Psychology Group,PLLC Clinical CurrentSince Jun 29, 2024 Accepting new patients

Locations

835 Mason St
Ste B220
Dearborn, MI 48124
Phone 3135619064 ext. 102

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1579219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748822400000",
    "number": "1447880463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 MASON ST STE B220",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242262",
            "telephone_number": "313-561-9064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 MASON ST STE B220",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242262",
            "telephone_number": "313-561-9064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOQUIN",
        "first_name": "OLIVIA",
        "middle_name": "ANN",
        "credential": "MS, LLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-17",
        "last_updated": "2025-06-02",
        "certification_date": "2025-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6361007867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.