Active NPI
Kim D Moss, PSY.D
- Psychologist
- Ellicott City, MD
National Provider Identifier
1831215292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 02739
- Practice address
- 3355 Saint Johns LN
Ste F
Ellicott City, MD 21042-2605 - Phone
- (410) 655-1834
- Fax
- (410) 480-0110
- NPI assigned
- Mar 21, 2007
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 02739 | MD | Primary |
Addresses
Primary practice location
3355 Saint Johns LN
Ste F
Ellicott City, MD 21042-2605
Mailing address
5588 Rhonda Rd
Sykesville, MD 21784-9021
Phone (410) 549-7360
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354752000000",
"number": "1831215292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5588 RHONDA RD",
"city": "SYKESVILLE",
"state": "MD",
"postal_code": "217849021",
"telephone_number": "410-549-7360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3355 SAINT JOHNS LN",
"address_2": "STE F",
"city": "ELLICOTT CITY",
"state": "MD",
"postal_code": "210422605",
"telephone_number": "410-655-1834",
"fax_number": "410-480-0110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSS",
"first_name": "KIM",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-21",
"last_updated": "2012-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MD",
"license": "02739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellicott City, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.