Healthcare Provider Details

I. General information

NPI: 1346172665
Provider Name (Legal Business Name): AIDEN MOORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 VIRGINIA RD STE 204
CONCORD MA
01742-2769
US

IV. Provider business mailing address

1009 MAIN ST
LEOMINSTER MA
01453-1909
US

V. Phone/Fax

Practice location:
  • Phone: 781-674-0000
  • Fax:
Mailing address:
  • Phone: 781-859-9973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number24-373562
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: