Provider Demographics
NPI:1972723013
Name:GUREASKO MOORE, DAVID PAUL (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:GUREASKO MOORE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 CARMEL AVE SUITE 210
Mailing Address - Street 2:SLS RESIDENTIAL INC
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509
Mailing Address - Country:US
Mailing Address - Phone:845-721-7262
Mailing Address - Fax:845-279-7678
Practice Address - Street 1:2505 CARMEL AVE SUITE 210
Practice Address - Street 2:SLS RESIDENTIAL INC
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509
Practice Address - Country:US
Practice Address - Phone:845-721-7262
Practice Address - Fax:845-279-7678
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015968103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist