Marie C Moore, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY15404 Issued in CA

Practice address

1145 Gayley Ave
Suite 322
Los Angeles, CA 90024-3423

Phone

(310) 991-5720

Fax

(310) 208-0684

NPI assigned

Feb 12, 2007

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

Other identifiers 1

Other names 1

• Ms. Marie O Moore Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jeanne Young, PHD, a Psychological Corporation

  • Clinical Psychologist
  • Los Angeles, CA
  • NPI 1023311354
  NPD (past)

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639211493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1145 GAYLEY AVE",
            "address_2": "SUITE 322",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900243423",
            "telephone_number": "310-991-5720",
            "fax_number": "310-208-0684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 GAYLEY AVE",
            "address_2": "SUITE 322",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900243423",
            "telephone_number": "310-991-5720",
            "fax_number": "310-208-0684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARIE",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY15404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PSY15404",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIE",
            "last_name": "MOORE",
            "middle_name": "O",
            "prefix": "MS.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Latonya Patrice Moore
• Laurencia Lonise Moore
• Linda F Moore
• Margaret O'Grady Moore, MA
• Maria Moore
• Mary Elizabeth Moore, M.D.
• Mi-Calynn Moore
• Mila Moore, FNP BC
• Nadgeda Moore, M.D.
• Nagi Moore

• Clinical Psychologist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.