Healthcare Provider Details

I. General information

NPI: 1073423679
Provider Name (Legal Business Name): AMBER R MOORE M.S., ED, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 GUINEA HILL RD
SLATE HILL NY
10973-4341
US

IV. Provider business mailing address

103 BENNEYWATER RD
PORT JERVIS NY
12771-3603
US

V. Phone/Fax

Practice location:
  • Phone: 845-355-3232
  • Fax:
Mailing address:
  • Phone: 845-283-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: