Moore, Stephanie Diane
Moore, Stephanie Diane is an sole proprietor health care provider with primary practice located at 567 Vauxhall Street Extension #107, Waterford CT 06385. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Moore, Stephanie Diane can be contacted via phone (860) 439-1980.Contact Information
Primary practice address
567 Vauxhall Street Extension #107
Waterford CT 06385
Phone: (860) 439-1980
Fax: (860) 388-4460
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 001668 | Connecticut |
Profile Details
| NPI number | 1396874087 |
|---|---|
| LBN Legal business name | Moore, Stephanie Diane |
| Credentials | PSY.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 5th, 2007 |
| Last updated | Jun 20th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1396874087 | NPPES |
| Connecticut | Other | 060001668CT02 | ANTHEM BLUE CROSS |
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