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General NPI Number Information
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NPI Number | 1396854030
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Entity Type | Individual
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Provider Name | GREGG A. MOORE LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 5776 STONERIDGE MALL RD STE 300
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City | PLEASANTON
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State | CA
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Zip | 94588-4522
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Country | US
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Telephone | 855-501-1004
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Fax | 925-556-0485
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Provider Business Mailing Address
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Address Line | 3835 N FREEWAY BLVD STE 100
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City | SACRAMENTO
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State | CA
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Zip | 95834-1954
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Country | US
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Telephone | 916-576-7900
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Fax | 916-277-9380
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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 | 93305
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R070522
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License Number State | NY
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