Active NPI
David Moyer, PHD
- Clinical Psychologist
- Manchester, CT
National Provider Identifier
1609950286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 00858
- Practice address
- 200 Main St
Manchester, CT 06042-3581 - Phone
- (860) 646-9660
- Fax
- (860) 643-4074
- NPI assigned
- Oct 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 00858 | CT | Primary |
Addresses
Primary practice location
200 Main St
Manchester, CT 06042-3581
Mailing address
200 Main St
Manchester, CT 06042-3581
Phone (860) 646-9660
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 82742 | Other | CT | CIGNA |
| 004009114 | Medicaid | CT | |
| 060000858CT01 | Other | CT | ANTHEM |
| 066401 | Other | CT | VALUE OPTIONS |
| 189527 | Other | CT | MHN |
| P765675 | Other | CT | OXFORD |
| 4210626 | Other | CT | AETNA |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00858 | CT | MD | Clinical Psychologist |
| 000858 | CT | MD | Pediatric Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297036800000",
"number": "1609950286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 MAIN ST",
"city": "MANCHESTER",
"state": "CT",
"postal_code": "060423581",
"telephone_number": "860-646-9660",
"fax_number": "860-643-4074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 MAIN ST",
"city": "MANCHESTER",
"state": "CT",
"postal_code": "060423581",
"telephone_number": "860-646-9660",
"fax_number": "860-643-4074"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOYER",
"first_name": "DAVID",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2011-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CT",
"license": "00858",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "82742",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004009114",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "060000858CT01",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "066401",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN",
"identifier": "189527",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P765675",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4210626",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Manchester, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.