Provider Demographics
NPI:1053875443
Name:MOSES, MIKINEE M (PSYD)
Entity type:Individual
Prefix:
First Name:MIKINEE
Middle Name:M
Last Name:MOSES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BEAR BROOK CT
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-2738
Mailing Address - Country:US
Mailing Address - Phone:646-670-7291
Mailing Address - Fax:
Practice Address - Street 1:6 BEAR BROOK CT
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2738
Practice Address - Country:US
Practice Address - Phone:516-366-2582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026960103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical