Marisa M. Moore, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

023077 Issued in NY

Practice address

3399 North Rd
Poughkeepsie, NY 12601-1387

Phone

(845) 575-3314

NPI assigned

Jun 8, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654646400000",
    "number": "1487383121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 SCHINDLER CT",
            "city": "WAPPINGERS FALLS",
            "state": "NY",
            "postal_code": "125904139",
            "telephone_number": "347-678-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3399 NORTH RD",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126011387",
            "telephone_number": "845-575-3314"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "38 Schindler Ct",
            "address_purpose": "LOCATION",
            "city": "Wappingers Falls",
            "state": "NY",
            "postal_code": "125904139",
            "country_code": "US",
            "telephone_number": "347-678-1202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARISA",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-08",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "023077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "NA",
            "affiliation": "N",
            "address_1": "3399 North Rd",
            "city": "Poughkeepsie",
            "state": "NY",
            "country_code": "US",
            "postal_code": "126011387",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Briana Montilla, LPN
• Kristin Montini, MSW
• Montrose Vamc
• Ellen Elizabeth Moore, M.S.; CCC-SLP
• Gwendolyn L Moore
• Sam Eugene Moore Jr., AMBULETTE
• Sarah Elizabeth Moore, CASAC-2
• Nikhilendhar Nag Mopuru
• Isabella R Mora, DC
• Lilybeth Morales, MD

• Psychologist in Poughkeepsie, NY
• Providers in Poughkeepsie, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.