MEDICARE: RONIEKA SHARAE MOORE LMSW

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	104100000X	Social Worker	24067	MD

General Provider Information

NPI Number	:	1477015675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONIEKA SHARAE MOORE LMSW

Provider Business Mailing Address
First Line	:	68 REGATTA BAY CT APT 406
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-6282
Country	:	US
Telephone Number	:	443-221-9434
Fax Number	:

Provider Business Practice Location Address
First Line	:	839 BESTGATE RD
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3472
Country	:	US
Telephone Number	:	410-222-6001
Fax Number	:

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

Provider Enumeration Date	:	04/05/2019
Last Update Date	:	04/05/2019

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Directions to “ RONIEKA SHARAE MOORE LMSW” Practice Location

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