Healthcare Provider Details

I. General information

NPI: 1992011357
Provider Name (Legal Business Name): JAMES MOORE BCBA-D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E SUNRISE HWY STE 500
VALLEY STREAM NY
11581-1233
US

IV. Provider business mailing address

106 GRIFFITH DR
PETAL MS
39465-3406
US

V. Phone/Fax

Practice location:
  • Phone: 866-352-5010
  • Fax: 718-504-5184
Mailing address:
  • Phone: 602-463-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-02-0969
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-001339
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: