Peter Andre Moisan, PHD
Individual provider Active NPI Psychologist · Valatie, NY
NPI 1598835175 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1598835175
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 013576 (NY)
- Practice address
- 3055 Route 9
Valatie, NY 12184-0570 - Phone
- (518) 758-2237
- Fax
- (518) 732-1137
- NPI assigned
- Nov 9, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1042 Kinderhook St
Valatie, NY 12184-9743
Phone (518) 610-8103
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040427001272 | NY | Practitioner - Clinical Psychologist | 5991792491 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY15331 | CA | MD | Psychologist |
| 7347 | MA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valatie Psychological Services, PLLC | Current |
Accepting new patients | |
| South County Psychiatric & Psychotherapy Center | Past |
Accepting new patients | |
| Dennis Marcus MD PC | Psychologist | Past | Accepting new patients |
| Columbia Memorial Hospital | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 013576 | NY | Yes |
| Psychologist | 103T00000X | 7347 | MA | |
| Psychologist | 103T00000X | PSY15331 | CA |
Addresses
Primary practice location
3055 Route 9
Valatie, NY 12184-0570
Mailing address
PO Box 570
Valatie, NY 12184
Phone (518) 758-2237
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01877090 | Medicaid | NY |
Other providers in Valatie, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.