Provider Demographics
NPI:1235326067
Name:MOORE, VALERIA LYNETTE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VALERIA
Middle Name:LYNETTE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HERONS RUN DR APT 219
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1760
Mailing Address - Country:US
Mailing Address - Phone:941-730-8807
Mailing Address - Fax:
Practice Address - Street 1:200 HERONS RUN DR APT 219
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-1760
Practice Address - Country:US
Practice Address - Phone:941-730-8807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7370103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical