Provider Demographics
NPI:1619774882
Name:MOSES, MARCUS A (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:A
Last Name:MOSES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 N WINERY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-4807
Mailing Address - Country:US
Mailing Address - Phone:559-216-0125
Mailing Address - Fax:559-201-6363
Practice Address - Street 1:2140 N WINERY AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-4807
Practice Address - Country:US
Practice Address - Phone:559-216-0125
Practice Address - Fax:559-201-6363
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist