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General NPI Number Information
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NPI Number | 1457547507
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Entity Type | Individual
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Provider Name | JEAN MOORE PHD
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Gender | Female
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Dates
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Enumeration Date | 09/22/2007
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Last Update Date | 09/22/2007
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Provider Practice Location Address
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Address Line | 26384 CARMEL RANCHO LN STE 200H
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City | CARMEL
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State | CA
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Zip | 93923-8750
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Country | US
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Telephone | 831-624-7810
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Fax | 831-626-0868
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Provider Business Mailing Address
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Address Line | PO BOX 223179
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City | CARMEL
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State | CA
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Zip | 93922-3179
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Country | US
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Telephone | 831-624-7810
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Fax | 831-626-0868
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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 | PSY11127
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License Number State | CA
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