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General NPI Number Information
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NPI Number | 1104988500
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Entity Type | Individual
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Provider Name | CHARLES N MOORE JR. D.MIN.
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 23 SPRING ST
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City | ESSEX
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State | MA
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Zip | 01929-1311
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Country | US
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Telephone | 978-884-8641
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Fax |
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Provider Business Mailing Address
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Address Line | 23 SPRING ST
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City | ESSEX
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State | MA
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Zip | 01929-1311
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Country | US
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Telephone | 978-884-8641
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2097
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | 2097
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 2097
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2097
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License Number State | MA
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