Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1447762950 |
---|---|
Provider Name | Adrianne Moore |
First Address | Newton, MA 02464-1573 |
Second Address | Newton, MA 02464-1573 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2017 |
Last Update Date | 25/10/2017 |