Healthcare Provider Details

I. General information

NPI: 1184546889
Provider Name (Legal Business Name): T MOORE PSYCHOTHERAPY LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 RICHMOND TER APT 5B
STATEN ISLAND NY
10310-1111
US

IV. Provider business mailing address

1470 RICHMOND TER APT 5B
STATEN ISLAND NY
10310-1111
US

V. Phone/Fax

Practice location:
  • Phone: 347-938-3491
  • Fax: 347-938-3491
Mailing address:
  • Phone: 347-938-3491
  • Fax: 347-938-3491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TROKOM HARRIS MOORE
Title or Position: OWNER
Credential: LCSW
Phone: 347-938-3491