Individual
DR. BRIAN LEOPOLD MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
7621 CANOGA AVE, CANOGA PARK, CA 91304-4912
(818) 642-1269
(818) 598-6937
Mailing address
7621 CANOGA AVE, CANOGA PARK, CA 91304-4912
(818) 642-1269
(818) 598-6977
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY13499
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GD050Y
PTAN
—
01
—
GD050Z
PTAN
—
Enumeration date
10/26/2006
Last updated
10/04/2012
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