Individual
KEENNA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
137 HARNED RD, COMMACK, NY 11725-4203
(631) 543-6765
Mailing address
193 MCKINLEY DR, MASTIC BEACH, NY 11951-5611
(631) 394-8778
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/30/2015
Last updated
03/30/2015
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