Healthcare Provider Details

I. General information

NPI: 1982806386
Provider Name (Legal Business Name): KAMARAUGH CERISE ANNQ MOORE L.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 E MAIN ST
COLUMBUS OH
43205-2140
US

IV. Provider business mailing address

1562 ALLENFORD CT
COLUMBUS OH
43232-1505
US

V. Phone/Fax

Practice location:
  • Phone: 614-251-0731
  • Fax: 614-252-8468
Mailing address:
  • Phone: 614-986-8367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS0500233
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: