Healthcare Provider Details

I. General information

NPI: 1669835609
Provider Name (Legal Business Name): ELIZABETH ANNE MOORE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MARTIN LUTHER KING DR E
CINCINNATI OH
45219-2581
US

IV. Provider business mailing address

311 MARTIN LUTHER KING DR E
CINCINNATI OH
45219-2581
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-5366
  • Fax: 513-475-5394
Mailing address:
  • Phone: 513-475-5366
  • Fax: 513-475-5394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS. 0900789
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: