Provider Demographics
NPI:1700934163
Name:MOORE, CAROLYN JO
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:JO
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-2827
Mailing Address - Country:US
Mailing Address - Phone:510-231-3945
Mailing Address - Fax:510-234-6613
Practice Address - Street 1:2525 MAINE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-2827
Practice Address - Country:US
Practice Address - Phone:510-231-3945
Practice Address - Fax:510-234-6613
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor