Healthcare Provider Details

I. General information

NPI: 1184039364
Provider Name (Legal Business Name): THOMAS MOORE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 LIBBEY INDUSTRIAL PKWY FL 2
WEYMOUTH MA
02189-3101
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 781-626-5463
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number10724
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: