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General NPI Number Information
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NPI Number | 1336795509
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Entity Type | Individual
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Provider Name | NICHOLAS M MOORE PSYD
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Gender | Male
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 7 BROOKVIEW DR
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City | ATCO
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State | NJ
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Zip | 08004-2931
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Country | US
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Telephone | 856-658-7653
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Fax |
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Provider Business Mailing Address
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Address Line | 10000 MIDLANTIC DR STE 101E
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City | MOUNT LAUREL
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State | NJ
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Zip | 08054-1504
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Country | US
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Telephone | 732-982-2888
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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 | PY10540
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS020137
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 07284
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35SI00631200
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License Number State | NJ
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