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NPI Code Detail

MEDICARE: MS. NICOLE R. MOORE MSW, CADC

MEDICARE: MS. NICOLE R. MOORE MSW, CADC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1265646632
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NICOLE R. MOORE MSW, CADC
Provider Business Mailing Address
First Line : 2999 PHILADELPHIA PIKE
Second Line :
City : CLAYMONT
State : DE
Zip : 19703-2507
Country : US
Telephone Number : 302-792-0700
Fax Number : 302-798-2608
Provider Business Practice Location Address
First Line : 2999 PHILADELPHIA PIKE
Second Line :
City : CLAYMONT
State : DE
Zip : 19703-2507
Country : US
Telephone Number : 302-792-0700
Fax Number : 302-798-2608
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2007
Last Update Date : 07/08/2007

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