Individual
DR. STEPHANIE DIANE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
567 VAUXHALL STREET EXTENSION, #107, WATERFORD, CT 06385
(860) 439-1980
(860) 388-4460
Mailing address
PO BOX 403, OLD SAYBROOK, CT 06475-0403
(860) 536-1536
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
001668
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060001668CT02
ANTHEM BLUE CROSS
CT
Enumeration date
03/05/2007
Last updated
06/20/2012
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