Provider Demographics
NPI:1497094700
Name:MOORE, THOMAS (BCBA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6132
Mailing Address - Country:US
Mailing Address - Phone:802-578-6539
Mailing Address - Fax:
Practice Address - Street 1:22 ORCHARD RD
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6132
Practice Address - Country:US
Practice Address - Phone:802-578-6539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT146.0120230103K00000X
VT11210175103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst