MEDICARE: MONICA DENISE MOORING DSW, MSW

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	LSW2304	HI
2	104100000X	Social Worker	LSW-2304	HI

General Provider Information

NPI Number	:	1639585425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA DENISE MOORING DSW, MSW

Provider Business Mailing Address
First Line	:	PO BOX 1772
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90733-1772
Country	:	US
Telephone Number	:	719-213-8773
Fax Number	:

Provider Business Practice Location Address
First Line	:	3959 MIRA LINDA PT
Second Line	:	APT. 1534
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-6907
Country	:	US
Telephone Number	:	719-213-8773
Fax Number	:

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

Provider Enumeration Date	:	07/01/2014
Last Update Date	:	10/18/2022

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