1902882533 NPI number — MARGARET CATHERINE MOORE LCSW

Table of content: MARGARET CATHERINE MOORE LCSW (NPI 1902882533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902882533 NPI number — MARGARET CATHERINE MOORE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
MARGARET
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SULLIVAN
Provider Other First Name:
MARGARET
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902882533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UCONN MEDICAL GROUP
Provider Second Line Business Mailing Address:
263 FARMINGTON AVENUE
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06030-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-679-6700
Provider Business Mailing Address Fax Number:
860-679-6736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UCONN MEDICAL GROUP
Provider Second Line Business Practice Location Address:
263 FARMINGTON AVENUE
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06030-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-679-6700
Provider Business Practice Location Address Fax Number:
860-679-6736
Provider Enumeration Date:
12/15/2005

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: 104100000X , with the licence number:  005049 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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