Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 021049-1 | NY |
Y | 103T00000X | Psychologist | 021049-1 | NY |
N | 103TC1900X | Counseling Psychologist | 021049-1 | NY |
NPI | 1093222010 |
---|---|
Provider Name | Dr. Leyonita Moore |
First Address | Madison, WI 53707-7236 |
Second Address | Madison, WI 53703-3834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2017 |
Last Update Date | 07/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021049 | LICENSE (01) | NY |
56974 | NATIONAL REGISTER OF HEALTH SERVICE PSYCHOLOGISTS (01) |