Healthcare Provider Details

I. General information

NPI: 1427044478
Provider Name (Legal Business Name): ELLANA C MOORS ACSW, LCSW, CAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1463 OAKFIELD DR. SUITE 113
BRANDON FL
33511
US

IV. Provider business mailing address

4422 E COLUMBUS DR.
TAMPA FL
33605
US

V. Phone/Fax

Practice location:
  • Phone: 863-248-3300
  • Fax: 863-534-7028
Mailing address:
  • Phone: 863-519-0575
  • Fax: 863-534-7028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW5385
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2126L
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: