Amanda L Moen, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

38514 Issued in TX

Practice address

1300 W Lancaster Ave
Fort Worth, TX 76102-3499

Phone

(682) 303-9200

Fax

(682) 303-9239

NPI assigned

Jun 5, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Cook Children'S Medical Center

  • Clinical Child & Adolescent Psychologist
  • Fort Worth, TX
  • NPI 1710702907
  Medicare reassignment NPD
• Cook Children'S Medical Center

  • Air Ambulance
  • Fort Worth, TX
  • NPI 1215907530
  NPD

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

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671494400000",
    "number": "1720570773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 W LANCASTER AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761023499",
            "telephone_number": "682-303-9200",
            "fax_number": "682-303-9239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 W LANCASTER AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761023499",
            "telephone_number": "682-303-9200",
            "fax_number": "682-303-9239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOEN",
        "first_name": "AMANDA",
        "middle_name": "L",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-05",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "38514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Modisette
• Modlin Development Resources PLLC
• Emily Carol Modlin, LMSW
• Laura L Moe, FNP
• Adaobi Moemenam, NP
• Lynet Bonareri Moenga, APRN
• Adris Moffett, LMSW
• Jessica Michelle Moffett, COTA
• Arya Mofidi, DDS
• Christine Michelle Mogan, LPC-A

• Psychologist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.