Provider Demographics
NPI:1538475371
Name:MOORE, ROBERT DWIGHT JR
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DWIGHT
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 TATUM RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3753
Mailing Address - Country:US
Mailing Address - Phone:978-895-7293
Mailing Address - Fax:978-537-3496
Practice Address - Street 1:45 SUMMER ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3228
Practice Address - Country:US
Practice Address - Phone:978-466-8392
Practice Address - Fax:978-537-3496
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA9654101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health