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General NPI Number Information
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NPI Number | 1902055775
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Entity Type | Individual
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Provider Name | SHENIKKA TAMSIN MOORE LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 08/01/2013
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Provider Practice Location Address
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Address Line | 1629 K ST NW SUITE 300
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City | WASHINGTON
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State | DC
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Zip | 20006-1602
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Country | US
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Telephone | 202-779-1828
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Fax |
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Provider Business Mailing Address
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Address Line | 3103 NAYLOR RD SE APT 201
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City | WASHINGTON
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State | DC
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Zip | 20020-1678
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Country | US
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Telephone | 860-916-7400
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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 | 0904007631
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50079096
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License Number State | DC
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