Provider Demographics
NPI:1235298084
Name:MOORE, MELISSA JAYNE (PHD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JAYNE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3825 PARADISE DR
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-1116
Mailing Address - Country:US
Mailing Address - Phone:415-379-1048
Mailing Address - Fax:415-750-1544
Practice Address - Street 1:6221 GEARY BLVD FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1821
Practice Address - Country:US
Practice Address - Phone:415-379-1048
Practice Address - Fax:415-750-1544
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor