Provider Demographics
NPI:1851798698
Name:MOORE, DANA W (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:W
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:WIEBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:69 SAND PIT RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4004
Mailing Address - Country:US
Mailing Address - Phone:203-748-2551
Mailing Address - Fax:203-790-6375
Practice Address - Street 1:69 SAND PIT RD
Practice Address - Street 2:SUITE 300
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4004
Practice Address - Country:US
Practice Address - Phone:203-748-2551
Practice Address - Fax:203-790-6375
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3392103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist