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General NPI Number Information
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NPI Number | 1861113342
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Entity Type | Individual
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Provider Name | KEVIN M MOORE
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Gender | Male
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Dates
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Enumeration Date | 09/05/2022
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Last Update Date | 09/05/2022
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Provider Practice Location Address
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Address Line | 8118 GOOD LUCK RD
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City | LANHAM
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State | MD
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Zip | 20706-3574
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Country | US
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Telephone | 301-552-5187
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Fax | 301-552-8668
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Provider Business Mailing Address
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Address Line | 8102 HUNTERS GREEN CT
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City | CLINTON
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State | MD
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Zip | 20735-2989
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Country | US
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Telephone | 301-873-3552
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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 | 11001
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License Number State | MD
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