Healthcare Provider Details

I. General information

NPI: 1982956181
Provider Name (Legal Business Name): BRITTANNI KORYN MOORE LPC,MA,BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3095 MAIN ST
STRATFORD CT
06614-4847
US

IV. Provider business mailing address

141 E MAIN ST 4TH FLOOR ADMINISTRATION
WATERBURY CT
06702-2310
US

V. Phone/Fax

Practice location:
  • Phone: 475-208-1359
  • Fax:
Mailing address:
  • Phone: 203-574-9000
  • Fax: 203-574-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2716
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: