Individual
DR. MARY ANN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
679 MAIN ST, JOHNSON CITY, NY 13790-1716
(607) 237-0645
Mailing address
119 OCONNELL RD, VESTAL, NY 13850-6001
(607) 239-8063
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
011128-1
NY
Other
Enumeration date
09/07/2020
Last updated
09/07/2020
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