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General NPI Number Information
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NPI Number | 1184762486
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Entity Type | Individual
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Provider Name | DORIS LOUISE MOORE PHD, MSW, RAS
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Gender | Female
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 05/07/2015
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Provider Practice Location Address
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Address Line | 25 ALLEN STREET
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City | MARTINEZ
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State | CA
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Zip | 94553-1513
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Country | US
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Telephone | 925-313-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 2951 DERBY STREET #214
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City | BERKELEY
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State | CA
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Zip | 94705-1973
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Country | US
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Telephone | 510-529-4506
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 29143
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License Number State | CA
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