Active NPI
Damon Moore
- Psychologist
- Grosse Pointe Park, MI
National Provider Identifier
1144829037
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6362009236
- Practice address
- 15450 E Jefferson Ave Ste 180
Grosse Pointe Park, MI 48230-2031 - Phone
- (313) 444-4393
- NPI assigned
- Oct 21, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | PP0000001037037 | MI | |
| Psychologist | 103T00000X | 6362009236 | MI | Primary |
Addresses
Primary practice location
15450 E Jefferson Ave Ste 180
Grosse Pointe Park, MI 48230-2031
Mailing address
25898 Chippendale CT Apt a
Roseville, MI 48066-3975
Phone (810) 937-9137
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6362009236 | MI | MD | Psychologist |
| PP0000001037037 | MI | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603238400000",
"number": "1144829037",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25898 CHIPPENDALE CT APT A",
"city": "ROSEVILLE",
"state": "MI",
"postal_code": "480663975",
"telephone_number": "810-937-9137"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15450 E JEFFERSON AVE STE 180",
"city": "GROSSE POINTE PARK",
"state": "MI",
"postal_code": "482302031",
"telephone_number": "313-444-4393"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "DAMON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-21",
"last_updated": "2020-10-21",
"certification_date": "2020-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "MI",
"license": "PP0000001037037",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6362009236",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grosse Pointe Park, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.