Healthcare Provider Details

I. General information

NPI: 1881144814
Provider Name (Legal Business Name): JACQUELINE A. MOYE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E 125TH ST # D6B
NEW YORK NY
10035-6000
US

IV. Provider business mailing address

600 E 125TH ST # D6B
NEW YORK NY
10035-6000
US

V. Phone/Fax

Practice location:
  • Phone: 646-672-6068
  • Fax:
Mailing address:
  • Phone: 646-672-6068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number083842
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: