Provider Demographics
NPI:1124184122
Name:MOORE, BARBARA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:J
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23910 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1524
Mailing Address - Country:US
Mailing Address - Phone:718-631-0978
Mailing Address - Fax:718-631-0978
Practice Address - Street 1:23910 42ND AVE
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11363-1524
Practice Address - Country:US
Practice Address - Phone:718-631-0978
Practice Address - Fax:718-631-0978
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011120-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01688691Medicaid
NY02622Medicare ID - Type UnspecifiedPSYCHOLOGIST