Provider Demographics
NPI:1821115098
Name:MOORE, JOSEPH WILLIAM (MA LMHC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:MOORE
Suffix:
Gender:M
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CENTRAL STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1036
Mailing Address - Country:US
Mailing Address - Phone:508-238-8088
Mailing Address - Fax:
Practice Address - Street 1:15A BOLTON PLACE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5316
Practice Address - Country:US
Practice Address - Phone:508-427-4383
Practice Address - Fax:508-584-4328
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health