Healthcare Provider Details

I. General information

NPI: 1386737781
Provider Name (Legal Business Name): EMILY DRIVER MOORE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 MILES RD SE
ALBUQUERQUE NM
87106-3224
US

IV. Provider business mailing address

2418 MILES RD SE
ALBUQUERQUE NM
87106-3224
US

V. Phone/Fax

Practice location:
  • Phone: 505-259-1414
  • Fax: 505-245-9161
Mailing address:
  • Phone: 505-259-1414
  • Fax: 505-245-9161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number486
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: