Basic Information
Provider Information
NPI: 1003146697
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MOORE
FirstName: CATHERINE
MiddleName: ELENI
NamePrefix:  
NameSuffix:  
Credential: M.ED., LCMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 816 COURT ST APT D
Address2:  
City: KEENE
State: NH
PostalCode: 034311706
CountryCode: US
TelephoneNumber: 6033527820
FaxNumber:  
Practice Location
Address1: CATHOLIC MEDICAL CENTER, 88 MCGREGOR ST.
Address2: 104
City: MANCHESTER
State: NH
PostalCode: 03102
CountryCode: US
TelephoneNumber: 6036686252
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/05/2010
LastUpdateDate: 06/16/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X934NHY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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