Healthcare Provider Details

I. General information

NPI: 1215721238
Provider Name (Legal Business Name): ROBERTA J MOOERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 GROVE ST
WORCESTER MA
01605-2651
US

IV. Provider business mailing address

50 FRANKLIN ST APT 908
WORCESTER MA
01608-1946
US

V. Phone/Fax

Practice location:
  • Phone: 774-391-6033
  • Fax:
Mailing address:
  • Phone: 508-688-7511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: