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General NPI Number Information
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NPI Number | 1558936344
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Entity Type | Individual
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Provider Name | CALEB MOORE
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Gender | Male
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Dates
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Enumeration Date | 05/24/2021
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 6956 SILVERTON AVE
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City | CINCINNATI
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State | OH
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Zip | 45236-3774
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Country | US
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Telephone | 740-457-9675
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD # 4453
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 740-354-6685
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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.2410900
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License Number State | OH
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