Individual
MR. STEPHEN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
100 ROSCOMMON DR, MIDDLETOWN, CT 06457-1591
(860) 343-5500
(860) 343-5509
Mailing address
100 ROSCOMMON DR, MIDDLETOWN, CT 06457-1591
(860) 343-5500
(860) 343-5509
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1070
CT
Other
Enumeration date
04/30/2015
Last updated
04/30/2015
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