MEDICARE: ASHLEY ROSE MOORE BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-18-31482	NJ
2	174400000X	Specialist

General Provider Information

NPI Number	:	1497126957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY ROSE MOORE BCBA

Provider Business Mailing Address
First Line	:	55 WOODLAND RD
Second Line	:
City	:	CHATHAM
State	:	NJ
Zip	:	07928-2008
Country	:	US
Telephone Number	:	973-886-7321
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 WOODLAND RD
Second Line	:
City	:	CHATHAM
State	:	NJ
Zip	:	07928-2008
Country	:	US
Telephone Number	:	973-886-7321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2015
Last Update Date	:	10/12/2018

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Directions to “ ASHLEY ROSE MOORE BCBA” Practice Location

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