Provider Demographics
NPI:1780891960
Name:MOORE, ADELIA (PHD)
Entity type:Individual
Prefix:DR
First Name:ADELIA
Middle Name:
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 1:120 W 15TH ST
Mailing Address - Street 2:APT. 2H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6790
Mailing Address - Country:US
Mailing Address - Phone:917-822-6319
Mailing Address - Fax:
Practice Address - Street 1:120 W 15TH ST
Practice Address - Street 2:APT. 2H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6790
Practice Address - Country:US
Practice Address - Phone:917-822-6319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015935-1103TC0700X
CT002109103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical