Provider Demographics
NPI:1952537490
Name:MOORE, JAMIE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:M
Other - Last Name:LINDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6050 GORGAS RD
Mailing Address - Street 2:
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-6206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WIESBADEN ARMY HEALTH CLINIC
Practice Address - Street 2:
Practice Address - City:WIESBADEN
Practice Address - State:DC
Practice Address - Zip Code:22060-6206
Practice Address - Country:US
Practice Address - Phone:314-590-1518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5380103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical