Doctor Name: | DR. CHARLES N MOORE |
NPI Number: | 1104988500 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.MIN. |
License Number: | 2097 |
Business Practice Address: | 23 Spring St Essex, MA - 019291311 |
Business Phone Number: | 9788848641 |
Business Fax Number: | |
Mailing Address: | 23 Spring St, ESSEX |
State: | MA |
Postal Code: | 019291311 |
Phone Number: | 9788848641 |
Fax Number: | |
NPI Enumeration Date: | 12/14/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 2097 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |