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1669656484 NPI number — MS. QUEENIE MAE MOORE

NPI Number: 1669656484
Health Care Provider/Practitioner: MS. QUEENIE MAE MOORE

Information about “1669656484” NPI (MS. QUEENIE MAE MOORE) exists in 1669656484 in HTML format HTML  |  1669656484 in plain Text format TXT  |  1669656484 in PDF (Portable Document Format) PDF  |  1669656484 in an XML format XML  formats.

NPI Number : 1669656484 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669656484",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MOORE",
    "FirstName": "QUEENIE",
    "MiddleName": "MAE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MOORE",
    "OtherFirstName": "QUEENIE",
    "OtherMiddleName": "CONNER",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MS, LADC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "221 HOWARD AVE",
    "SecondLineMailingAddress": "NONE",
    "MailingAddressCityName": "NEW HAVEN",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06519-2727",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "203-781-4646",
    "MailingAddressFaxNumber": "203-781-4705",
    "FirstLinePracticeLocationAddress": "1415 STATE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEW HAVEN",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06511-2702",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "203-691-1038",
    "PracticeLocationAddressFaxNumber": "203-691-1038",
    "EnumerationDate": "12/28/2007",
    "LastUpdateDate": "12/28/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101Y00000X",
        "TaxonomyName": "Counselor",
        "LicenseNumber": "000755",
        "LicenseNumberStateCode": "CT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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