=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942947957
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZAKIYYAH M. MOORE LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2022
-----------------------------------------------------
Last Update Date | 05/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2999 FREDERICK DOUGLASS BLVD APT 23A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10039-0047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-327-4233
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2999 FREDERICK DOUGLASS BLVD APT 23A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10039-0047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-327-4233
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 113039
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------