Healthcare Provider Details

I. General information

NPI: 1861057150
Provider Name (Legal Business Name): MONIQUE MOORE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 CONNECTICUT AVE NW STE 137A
WASHINGTON DC
20008-2683
US

IV. Provider business mailing address

3904 INGOMAR ST NW
WASHINGTON DC
20015-1916
US

V. Phone/Fax

Practice location:
  • Phone: 202-290-0216
  • Fax: 202-299-0216
Mailing address:
  • Phone: 202-297-9407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MONIQUE S MOORE
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 202-299-0216