| Doctor Name: | MR. THEODORE ALAN MOORE |
| NPI Number: | 1134290695 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.A. |
| License Number: | 37PC00015000 |
| Business Practice Address: | 130 Route 31 N Suite D Pennington, NJ - 085343620 |
| Business Phone Number: | 6097308282 |
| Business Fax Number: | 6097308282 |
| Mailing Address: | 130 Route 31 N, Suite D PENNINGTON |
| State: | NJ |
| Postal Code: | 085343620 |
| Phone Number: | 6097308282 |
| Fax Number: | 6097308282 |
| NPI Enumeration Date: | 11/13/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 37PC00015000 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |