Provider Demographics
NPI:1013554054
Name:MOORE, KRISSA L (MS)
Entity Type:Individual
Prefix:MRS
First Name:KRISSA
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:KRISSA
Other - Middle Name:L
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-0173
Mailing Address - Country:US
Mailing Address - Phone:856-397-4628
Mailing Address - Fax:
Practice Address - Street 1:33 DEASY DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-2750
Practice Address - Country:US
Practice Address - Phone:856-397-4628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00702400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health