1225167836 NPI number — MS. DOROTHY VIRGINIA MOORE LCSW-C,BCD

Table of content: MS. DOROTHY VIRGINIA MOORE LCSW-C,BCD (NPI 1225167836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225167836 NPI number — MS. DOROTHY VIRGINIA MOORE LCSW-C,BCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
DOROTHY
Provider Middle Name:
VIRGINIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C,BCD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225167836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
416 KIMBLEWICK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20904-6320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-680-7916
Provider Business Mailing Address Fax Number:
301-680-7916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11161 NEW HAMPSHIRE AVE
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20904-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-593-6554
Provider Business Practice Location Address Fax Number:
301-754-1034
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  01027 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com