Healthcare Provider Details

I. General information

NPI: 1497400436
Provider Name (Legal Business Name): SHIMENA RENAE MOORE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARKAVIEW RD NW
HUNTSVILLE AL
35805-3652
US

IV. Provider business mailing address

222 KYSER BLVD APT 9
MADISON AL
35758-2305
US

V. Phone/Fax

Practice location:
  • Phone: 256-535-3100
  • Fax:
Mailing address:
  • Phone: 256-541-0947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3220G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: