Provider Demographics
NPI:1255492468
Name:MOORE, DENNIS RAY (MA, NCSP)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:RAY
Last Name:MOORE
Suffix:
Gender:M
Credentials:MA, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:258 SOUTH STATE STREET
Mailing Address - Street 2:R & L OFFICE CENTER
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940
Mailing Address - Country:US
Mailing Address - Phone:215-860-2240
Mailing Address - Fax:215-860-6778
Practice Address - Street 1:258 SOUTH STATE STREET
Practice Address - Street 2:R & L OFFICE CENTER
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940
Practice Address - Country:US
Practice Address - Phone:215-860-2240
Practice Address - Fax:215-860-6778
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004703L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR07566Medicare UPIN