Healthcare Provider Details

I. General information

NPI: 1639099070
Provider Name (Legal Business Name): SHARON MOORE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 THAYER AVE
SILVER SPRING MD
20910-5160
US

IV. Provider business mailing address

11215 GEORGIA AVE APT 1517
SILVER SPRING MD
20902-7666
US

V. Phone/Fax

Practice location:
  • Phone: 678-536-6878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30714
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: