Healthcare Provider Details

I. General information

NPI: 1215848882
Provider Name (Legal Business Name): CODY MOORE MSW, LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W CHESTNUT ST APT 707
WASHINGTON PA
15301-4411
US

IV. Provider business mailing address

235 W CHESTNUT ST APT 707
WASHINGTON PA
15301-4411
US

V. Phone/Fax

Practice location:
  • Phone: 304-940-3533
  • Fax:
Mailing address:
  • Phone: 304-940-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberBP00947664
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: