Provider Demographics
NPI:1164578878
Name:MOORE, JANET MILLER
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:MILLER
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 CAMPFIRE CV
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-2595
Mailing Address - Country:US
Mailing Address - Phone:904-502-9272
Mailing Address - Fax:904-502-9272
Practice Address - Street 1:138 CAMPFIRE CV
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:FL
Practice Address - Zip Code:32439-2595
Practice Address - Country:US
Practice Address - Phone:904-502-9272
Practice Address - Fax:904-276-7078
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-08-4814103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst