Provider Demographics
NPI:1508265067
Name:MOON, NATHAN ROBERT (MA, PSYD, ABPP)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ROBERT
Last Name:MOON
Suffix:
Gender:M
Credentials:MA, PSYD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL HEALTH CLINIC HAWAII 480 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:PEARL HARBOR
Mailing Address - State:HI
Mailing Address - Zip Code:96860
Mailing Address - Country:US
Mailing Address - Phone:808-496-3365
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HEALTH CLINIC HAWAII, 480 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:JPBHH
Practice Address - State:HI
Practice Address - Zip Code:96860
Practice Address - Country:US
Practice Address - Phone:808-496-3365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1328103T00000X
NMPSY1328103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist