Individual
LATREASE R MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
1612 GENESEE ST, UTICA, NY 13502-5425
(315) 724-5173
Mailing address
1612 GENESEE ST, UTICA, NY 13502-5425
(315) 724-5173
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
005071
NY
103TC0700X
Clinical Psychologist
Primary
024435-01
NY
Other
Enumeration date
02/11/2016
Last updated
12/01/2021
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