1952461444 NPI number — MS. MAURA MCGOVERN MOORE LCSW

Table of content: MS. MAURA MCGOVERN MOORE LCSW (NPI 1952461444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952461444 NPI number — MS. MAURA MCGOVERN MOORE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
MAURA
Provider Middle Name:
MCGOVERN
Provider Name Prefix Text:
MS.
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:
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:
1952461444
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16733
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-431-0119
Provider Business Mailing Address Fax Number:
540-684-6184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1707 OSAGE ST
Provider Second Line Business Practice Location Address:
STE 404
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22302-2611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-431-0119
Provider Business Practice Location Address Fax Number:
540-684-6184
Provider Enumeration Date:
12/12/2006

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:  0904005555 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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