Provider Demographics
NPI:1861594293
Name:MOYAR, MARJORIE MARIA (PHD)
Entity type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:MARIA
Last Name:MOYAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2915 FAIRFAX RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4015
Mailing Address - Country:US
Mailing Address - Phone:216-577-1560
Mailing Address - Fax:216-464-3951
Practice Address - Street 1:3690 ORANGE PLACE
Practice Address - Street 2:STE 410
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-464-3666
Practice Address - Fax:216-464-3951
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3422103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP07401Medicare PIN