Healthcare Provider Details

I. General information

NPI: 1467312504
Provider Name (Legal Business Name): ROSEMARY MOORE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4239 S BROWNELL RD
WILLISTON VT
05495-7296
US

IV. Provider business mailing address

3280 RUE DE RUSHBROOKE
VERDUN QC
H4G 1S7
CA

V. Phone/Fax

Practice location:
  • Phone: 802-328-9859
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number097.0136694
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: