Provider Demographics
NPI:1659709004
Name:MOORE, KEIRA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:KEIRA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 RUMFORD AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3845
Mailing Address - Country:US
Mailing Address - Phone:518-588-7496
Mailing Address - Fax:
Practice Address - Street 1:18 RUMFORD AVE
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-3845
Practice Address - Country:US
Practice Address - Phone:518-588-7496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst