Provider Demographics
NPI:1528098456
Name:RIPLEY, MOIRA P (PSYD)
Entity type:Individual
Prefix:DR
First Name:MOIRA
Middle Name:P
Last Name:RIPLEY
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 1:1 COURT ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1358
Mailing Address - Country:US
Mailing Address - Phone:603-442-9393
Mailing Address - Fax:603-442-9393
Practice Address - Street 1:1 COURT ST
Practice Address - Street 2:SUITE 330
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1358
Practice Address - Country:US
Practice Address - Phone:603-442-9393
Practice Address - Fax:603-442-9393
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2015-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-852103TC0700X
NH1076103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT789467000OtherMAGELLAN PROVIDER NUMBER
NH06Y008268VT01OtherANTHEM BCBS PROVIDER NUMB
VT00068590OtherBCBSVT PROVIDER NUMBER
VT1011090Medicaid