Provider Demographics
NPI:1558648519
Name:MOOR, MARY VAUGHN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:VAUGHN
Last Name:MOOR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1518 SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958
Mailing Address - Country:US
Mailing Address - Phone:302-448-4266
Mailing Address - Fax:302-448-4193
Practice Address - Street 1:1518 SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958
Practice Address - Country:US
Practice Address - Phone:302-448-4266
Practice Address - Fax:302-448-4193
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000901103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE510402460Medicaid
DE510402460Medicaid