Healthcare Provider Details

I. General information

NPI: 1407187776
Provider Name (Legal Business Name): DANIELLE J. MOORE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 PIERCE ST STE 200
RIVERSIDE CA
92505-4400
US

IV. Provider business mailing address

11801 PIERCE ST STE 200
RIVERSIDE CA
92505-4400
US

V. Phone/Fax

Practice location:
  • Phone: 909-726-0073
  • Fax:
Mailing address:
  • Phone: 909-726-0073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number59629
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number59629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: