Provider Demographics
NPI:1336343144
Name:MOORE, MARTHA CAROLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:CAROLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34930 ROAD 223
Mailing Address - Street 2:
Mailing Address - City:NORTH FORK
Mailing Address - State:CA
Mailing Address - Zip Code:93643-9647
Mailing Address - Country:US
Mailing Address - Phone:559-760-6154
Mailing Address - Fax:
Practice Address - Street 1:34930 ROAD 223
Practice Address - Street 2:
Practice Address - City:NORTH FORK
Practice Address - State:CA
Practice Address - Zip Code:93643-9647
Practice Address - Country:US
Practice Address - Phone:559-760-6154
Practice Address - Fax:559-877-4009
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19380103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical