Individual
MS. QUEENIE MAE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1415 STATE ST, NEW HAVEN, CT 06511-2702
(203) 691-1038
(203) 691-1038
Mailing address
221 HOWARD AVE, NONE, NEW HAVEN, CT 06519-2727
(203) 781-4646
(203) 781-4705
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
000755
CT
Other
Enumeration date
12/28/2007
Last updated
12/28/2007
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