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Individual

DR. KENNETH STEVEN MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MHP

Contact information

Practice address
100 LEDGEHILL RD, BENNINGTON, VT 05201-2273
(802) 442-5491
Mailing address
100 LEDGEHILL RD, BENNINGTON, VT 05201-2273
(802) 442-5491

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
103TF0000X
Family Psychologist
0970113490
VT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0970113490
BCBS
VT
Enumeration date
10/07/2015
Last updated
12/22/2015
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