MEDICARE: AMY 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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	093241-01	NY

General Provider Information

NPI Number	:	1588043889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MOORE

Provider Business Mailing Address
First Line	:	5040 TIBBETT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-3414
Country	:	US
Telephone Number	:	646-470-7741
Fax Number	:

Provider Business Practice Location Address
First Line	:	5040 TIBBETT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-3414
Country	:	US
Telephone Number	:	646-470-7741
Fax Number	:

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

Provider Enumeration Date	:	05/20/2015
Last Update Date	:	02/21/2024

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Directions to “ AMY MOORE ” Practice Location

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