Provider Demographics
NPI:1902138399
Name:MOSS, ALEXANDRA EMILY (RN, APRN, NP, BC)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:EMILY
Last Name:MOSS
Suffix:
Gender:F
Credentials:RN, APRN, NP, BC
Other - Prefix:MS
Other - First Name:SACHA
Other - Middle Name:EMILY
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, APRN, NP, BC
Mailing Address - Street 1:2430 PAUL MINNIE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:576 RUBBER AVE
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-3751
Practice Address - Country:US
Practice Address - Phone:203-500-3208
Practice Address - Fax:475-227-2085
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT071540163WP0808X
CA95014615363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008040753Medicaid
MAZIP: 01040Other2ND PRACTICE: RIVER VALLEY COUNSELING CENTER, INC., 303 BEECH ST., HOLYOKE, MA