Active NPI
Mary Moore, MA
- Psychologist
- Kalamazoo, MI
National Provider Identifier
1760683049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301007034
- Practice address
- 200 Turwill LN
Kalamazoo, MI 49006-4277 - Phone
- (269) 344-4413
- NPI assigned
- May 31, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301007034 | MI | Primary |
Addresses
Primary practice location
200 Turwill LN
Kalamazoo, MI 49006-4277
Mailing address
2115 Broadway Ave
Kalamazoo, MI 49008-1614
Phone (269) 344-4413
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301007034 | MI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760683049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2115 BROADWAY AVE",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490081614",
"telephone_number": "269-344-4413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 TURWILL LN",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490064277",
"telephone_number": "269-344-4413"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "MARY",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301007034",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kalamazoo, MI
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.