| Doctor Name: | ROSSANA MOULTON |
| NPI Number: | 1619189412 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | M-04921 |
| Business Practice Address: | 4950 Mc Nutt Rd Sunland Park, NM - 88063 |
| Business Phone Number: | 5058826200 |
| Business Fax Number: | |
| Mailing Address: | Po Drawer 70, ANTHONY |
| State: | NM |
| Postal Code: | 88021 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/04/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041S0200X |
| License Number: | M-04921 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |