Provider Demographics
NPI:1225138282
Name:MOORE, JAMES VERNON (PHD MS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:VERNON
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHD MS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1844 SAN MIGUEL DRIVE
Mailing Address - Street 2:# 300A
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-8612
Mailing Address - Country:US
Mailing Address - Phone:925-935-4448
Mailing Address - Fax:925-935-5135
Practice Address - Street 1:1844 SAN MIGUEL DR
Practice Address - Street 2:# 300A
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4962
Practice Address - Country:US
Practice Address - Phone:925-935-4448
Practice Address - Fax:925-935-5135
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY4917103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00PL49171Medicare ID - Type Unspecified