Provider Demographics
NPI:1437728979
Name:MOORE, CAROLINE BATCHELOR (PSYD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:BATCHELOR
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 1:420 S RIVER LANDING RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-1551
Mailing Address - Country:US
Mailing Address - Phone:443-714-8544
Mailing Address - Fax:
Practice Address - Street 1:420 S RIVER LANDING RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-1551
Practice Address - Country:US
Practice Address - Phone:443-714-8544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-20
Last Update Date:2021-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04073103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical