Provider Demographics
NPI:1417400532
Name:MOORE, CLAUDETTE
Entity Type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4052 EASTRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-1844
Mailing Address - Country:US
Mailing Address - Phone:786-512-2960
Mailing Address - Fax:
Practice Address - Street 1:4052 EASTRIDGE CIR
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-1844
Practice Address - Country:US
Practice Address - Phone:786-512-2960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst