Provider Demographics
NPI:1952491409
Name:MOORE, ANDREA LEIGH (LPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEIGH
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DEER RUN
Mailing Address - Street 2:CANDLEWOOD ISLE
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812
Mailing Address - Country:US
Mailing Address - Phone:203-746-4997
Mailing Address - Fax:
Practice Address - Street 1:457 N MAIN ST
Practice Address - Street 2:SUITE 2-A
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-4700
Practice Address - Country:US
Practice Address - Phone:203-790-9960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001131101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health