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General NPI Number Information
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NPI Number | 1174033559
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Entity Type | Individual
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Provider Name | ZACHARY MOORE LSW
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Gender | Male
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 10/11/2017
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Provider Practice Location Address
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Address Line | 4600 CARNEGIE AVE
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City | CLEVELAND
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State | OH
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Zip | 44103-4371
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Country | US
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Telephone | 216-431-7571
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Fax |
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Provider Business Mailing Address
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Address Line | 885 COMMERCE DR
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City | PERRYSBURG
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State | OH
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Zip | 43551-5267
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Country | US
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Telephone | 419-330-1649
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.1700741
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License Number State | OH
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