Provider Demographics
NPI:1982779674
Name:MOONSTARR, NANCY JOAN (PHD & LPC)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:JOAN
Last Name:MOONSTARR
Suffix:
Gender:F
Credentials:PHD & LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4630
Mailing Address - Country:US
Mailing Address - Phone:410-431-8870
Mailing Address - Fax:410-431-7177
Practice Address - Street 1:4 RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4630
Practice Address - Country:US
Practice Address - Phone:410-431-8870
Practice Address - Fax:410-431-7177
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000166103T00000X
MDLC0408101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPSY1000166OtherPSYCHOLOGIST LICENSE
MD188103500Medicaid
MDLC0408OtherLCPC
DCPSY1000166OtherPSYCHOLOGIST LICENSE