Provider Demographics
NPI:1619287224
Name:MOORE, TERESA MARY (MS, NCC)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:MARY
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COUNS & PSYCHOLOGICAL SVCS U C BERKELEY
Mailing Address - Street 2:2222 BANCROFT WAY
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-4300
Mailing Address - Country:US
Mailing Address - Phone:510-642-5724
Mailing Address - Fax:510-642-2368
Practice Address - Street 1:COUNS & PSYCHOLOGICAL SVCS U C BERKELEY
Practice Address - Street 2:2222 BANCROFT WAY
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4300
Practice Address - Country:US
Practice Address - Phone:510-642-5724
Practice Address - Fax:510-642-2368
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor