MEDICARE: KIARA MOORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS 28618	CA
2	104100000X	Social Worker	094694	NY

General Provider Information

NPI Number	:	1144413774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIARA MOORE

Provider Business Mailing Address
First Line	:	1255 AMSTERDAM AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-5927
Country	:	US
Telephone Number	:	626-403-4370
Fax Number	:

Provider Business Practice Location Address
First Line	:	1255 AMSTERDAM AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-5927
Country	:	US
Telephone Number	:	626-403-4370
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	04/28/2015

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Directions to “ KIARA MOORE ” Practice Location

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