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General NPI Number Information
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NPI Number | 1730808577
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Entity Type | Individual
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Provider Name | ALEXA NICOLE MOORE LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 273 E 7TH ST
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City | BLOOMSBURG
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State | PA
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Zip | 17815-2853
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Country | US
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Telephone | 570-507-7170
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 ROSLYN DR
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City | BERWICK
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State | PA
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Zip | 18603-2442
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Country | US
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Telephone | 717-793-1263
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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 | CW025776
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License Number State | PA
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