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General NPI Number Information
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NPI Number | 1649262767
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Entity Type | Individual
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Provider Name | ELSIE MARIE MOORE LICSW
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Gender | Female
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8901 WISCONSIN AVE NNMC BREAST CARE CENTER BLDG 10, 4 WEST
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City | BETHESDA
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State | MD
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Zip | 20889-0001
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Country | US
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Telephone | 301-295-6360
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Fax | 301-295-9076
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Provider Business Mailing Address
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Address Line | 5710 38TH AVE
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City | HYATTSVILLE
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State | MD
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Zip | 20782-3828
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Country | US
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Telephone | 301-985-3085
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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 | LC302949
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License Number State | DC
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