Provider Demographics
NPI:1184916249
Name:MOORE, DONNA A (MENTAL HEALTH COUNSE)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:MENTAL HEALTH COUNSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 40A 71ST CRESCENT 3C
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3723
Mailing Address - Country:US
Mailing Address - Phone:347-241-1478
Mailing Address - Fax:
Practice Address - Street 1:188 40A 71ST CRESCENT
Practice Address - Street 2:3C
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-3723
Practice Address - Country:US
Practice Address - Phone:347-241-1478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health