Healthcare Provider Details

I. General information

NPI: 1447818539
Provider Name (Legal Business Name): CATHERINE MOORE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PARKMAN ST
BOSTON MA
02114-3117
US

IV. Provider business mailing address

271 GREAT PLAIN AVE
NEEDHAM MA
02492-4129
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-5600
  • Fax:
Mailing address:
  • Phone: 781-343-1767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2317087
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2317087
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: