Provider Demographics
NPI:1619991411
Name:MOORE, GREGORY HERBERT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:HERBERT
Last Name:MOORE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 CLARKSVILLE RD
Mailing Address - Street 2:SUITE 7-A
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-5300
Mailing Address - Country:US
Mailing Address - Phone:609-275-8808
Mailing Address - Fax:609-275-9655
Practice Address - Street 1:231 CLARKSVILLE RD
Practice Address - Street 2:SUITE 7-A
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-5300
Practice Address - Country:US
Practice Address - Phone:609-275-8808
Practice Address - Fax:609-275-9655
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2833103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily