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General NPI Number Information
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NPI Number | 1336532662
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Entity Type | Individual
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Provider Name | SOBHUZA MOORE M.A., LMHC, NCC
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Gender | Male
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Dates
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Enumeration Date | 03/11/2015
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 124 E 40TH ST RM 404
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City | NEW YORK
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State | NY
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Zip | 10016-1764
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Country | US
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Telephone | 646-801-5316
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 339
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City | BRONX
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State | NY
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Zip | 10463-0339
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Country | US
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Telephone | 646-801-5316
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P94094
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License Number State | NY
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