Healthcare Provider Details

I. General information

NPI: 1982482972
Provider Name (Legal Business Name): JULIA A MOORE LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E MAIN ST
COLUMBUS OH
43215-5222
US

IV. Provider business mailing address

591 KING GEORGE AVE
COLUMBUS OH
43230-2311
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-1100
  • Fax:
Mailing address:
  • Phone: 614-517-9445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2506878
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: