Provider Demographics
NPI:1083460919
Name:MOORE, BRIANNA IRIS
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:IRIS
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:IRIS
Other - Last Name:LAUREANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1520 CARRIAGE BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6120
Mailing Address - Country:US
Mailing Address - Phone:689-253-4959
Mailing Address - Fax:
Practice Address - Street 1:1920 PALM BEACH LAKES BLVD STE 211
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3506
Practice Address - Country:US
Practice Address - Phone:561-721-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health