MEDICARE: YVONNE MOORE MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	03-531712	CT

General Provider Information

NPI Number	:	1063952380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE MOORE MSW

Provider Business Mailing Address
First Line	:	13040 229TH ST
Second Line	:
City	:	LAURELTON
State	:	NY
Zip	:	11413-1837
Country	:	US
Telephone Number	:	646-404-8518
Fax Number	:

Provider Business Practice Location Address
First Line	:	1027 E 216TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-1206
Country	:	US
Telephone Number	:	347-913-4373
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2017
Last Update Date	:	03/06/2017

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