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1679621775 NPI number — CYRESE MARIE MOORE LCSW

NPI Number: 1679621775
Health Care Provider/Practitioner: CYRESE MARIE MOORE LCSW

Information about “1679621775” NPI (CYRESE MARIE MOORE LCSW) exists in 1679621775 in HTML format HTML  |  1679621775 in plain Text format TXT  |  1679621775 in PDF (Portable Document Format) PDF  |  1679621775 in an XML format XML  formats.

NPI Number : 1679621775 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679621775",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MOORE",
    "FirstName": "CYRESE",
    "MiddleName": "MARIE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DEARING",
    "OtherFirstName": "CYRESE",
    "OtherMiddleName": "MAIRE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LCSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1502 W NC HIGHWAY 54",
    "SecondLineMailingAddress": "STE 103",
    "MailingAddressCityName": "DURHAM",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27707-5572",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "919-354-0840",
    "MailingAddressFaxNumber": "919-748-4441",
    "FirstLinePracticeLocationAddress": "4 DOCTORS PARK STE H",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ASHEVILLE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28801-4523",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "828-285-9911",
    "PracticeLocationAddressFaxNumber": "828-285-9970",
    "EnumerationDate": "01/08/2007",
    "LastUpdateDate": "03/17/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "SW12111",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "C009642",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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