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VERNON MOORE BGA
Clinical >> Social Worker >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1942638671
Individual Registrant: VERNON MOORE BGA
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
7.5 NORTH THIRD AVE TAFTVILLE, CT 06380 US
Tel: 404-918-5827 Fax: --
Tel: 404-918-5827 Fax: --
Contact information for business:
255 HEMPSTEAD ST NEW LONDON, CT 06320-6204 US
Tel: 860-443-2896 Fax: 860-442-5909
Tel: 860-443-2896 Fax: 860-442-5909
Registration Information:
NPI: 1942638671
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1041C0700X | Behavioral Health & Social Service Providers Social Worker Clinical |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
