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NPI Code Detail

MEDICARE: MS. QUEENIE MAE MOORE

MEDICARE: MS. QUEENIE MAE MOORE
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
1101Y00000XCounselor000755CT

General Provider Information

NPI Number : 1669656484
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. QUEENIE MAE MOORE
Provider Business Mailing Address
First Line : 221 HOWARD AVE
Second Line : NONE
City : NEW HAVEN
State : CT
Zip : 06519-2727
Country : US
Telephone Number : 203-781-4646
Fax Number : 203-781-4705
Provider Business Practice Location Address
First Line : 1415 STATE ST
Second Line :
City : NEW HAVEN
State : CT
Zip : 06511-2702
Country : US
Telephone Number : 203-691-1038
Fax Number : 203-691-1038
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2007
Last Update Date : 12/28/2007

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Directions to “ MS. QUEENIE MAE MOORE ” Practice Location

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