Peter Jerome Moulton
Student in an Organized Health Care Education/Training Program in Waltham, MA. Individual provider (NPI-1).
NPI number1669952032
StatusActive
Last updated in NPPESSep 20, 2019
Details
- NPI
- 1669952032
- Entity type
- Individual (NPI-1)
- Name
- Peter Jerome Moulton
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Aug 15, 2018
- Last updated
- Sep 20, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
| 101YM0800X | Counselor, Mental Health | – | MA |
Practice location
77 Rumford AveWaltham, MA 02453-3872
Phone 781-894-4325
Mailing address
77 Rumford AveWaltham, MA 02453-3872
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All 36 Student in an Organized Health Care Education/Training Program providers in Waltham · All 2,572 providers in Waltham
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