MEDICARE: DR. EILEEN KENNEDY-MOORE PH.D.

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	103T00000X	Psychologist	4254	NJ

General Provider Information

NPI Number	:	1922025758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EILEEN KENNEDY-MOORE PH.D.

Provider Business Mailing Address
First Line	:	131 N MAIN ST
Second Line	:
City	:	CRANBURY
State	:	NJ
Zip	:	08512-3319
Country	:	US
Telephone Number	:	609-395-1456
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 EWING ST
Second Line	:	SUITE C9
City	:	PRINCETON
State	:	NJ
Zip	:	08540-2757
Country	:	US
Telephone Number	:	609-655-2010
Fax Number	:

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	03/17/2026

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