Provider Demographics
NPI:1407883366
Name:MOORE, GEORGE V JR
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:V
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 LONG HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5063
Mailing Address - Country:US
Mailing Address - Phone:860-347-9911
Mailing Address - Fax:860-347-6413
Practice Address - Street 1:16 MEADOW LN
Practice Address - Street 2:
Practice Address - City:CANTERBURY
Practice Address - State:CT
Practice Address - Zip Code:06331-1821
Practice Address - Country:US
Practice Address - Phone:860-305-2083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001602104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
061038160OtherCHAMPUS TRICARE
CT140001602CT02OtherBCBS
722242000OtherUBH
722242000OtherMAGELLAN
P3192844OtherOXFORD
2195892OtherCIGNA
254506OtherMHN
CT4397705OtherAETNA
512845OtherVALUE OPTIONS
2195892OtherCIGNA