Provider Demographics
NPI:1568286961
Name:MOORE, KAY P (PSYD)
Entity type:Individual
Prefix:DR
First Name:KAY
Middle Name:P
Last Name:MOORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TIGER DR
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-1140
Mailing Address - Country:US
Mailing Address - Phone:410-658-9115
Mailing Address - Fax:410-658-9121
Practice Address - Street 1:100 TIGER DR
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-1140
Practice Address - Country:US
Practice Address - Phone:410-658-9115
Practice Address - Fax:410-658-9121
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCER-171483-B7F6C5103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool