Basic Information
| Provider Information | |||||||||
| NPI: | 1841268919 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOULTON | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | CEONA | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33 WARREN ST | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032261999 | ||||||||
| FaxNumber: | 6032241675 | ||||||||
| Practice Location | |||||||||
| Address1: | 33 WARREN ST | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032261999 | ||||||||
| FaxNumber: | 6032241675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 865 | NH | X | Behavioral Health & Social Service Providers | Psychologist | Clinical | 363LP0808X | 0336082305 | NH | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.