Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1184039364 |
---|---|
Provider Name | Thomas Moore |
First Address | Weymouth, MA 02189-3101 |
Second Address | Weymouth, MA 02189-3101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2014 |
Last Update Date | 17/03/2018 |