Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 0-02-0552 | FL |
NPI | 1164578878 |
---|---|
Provider Name | Janet Miller Moore |
First Address | Orange Park, FL 32073-5088 |
Second Address | Orange Park, FL 32073-5088 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 08/07/2007 |