MEDICARE: MRS. LINDSEY CLARKE MOORE LICSW, LCSW

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	0904007280	VA
2	1041C0700X	Clinical Social Worker	LC50078703	DC

General Provider Information

NPI Number	:	1093047961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDSEY CLARKE MOORE LICSW, LCSW

Provider Business Mailing Address
First Line	:	1707 BELLE VIEW BLVD
Second Line	:	SUITE C-2
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-6727
Country	:	US
Telephone Number	:	571-289-9729
Fax Number	:

Provider Business Practice Location Address
First Line	:	1707 BELLE VIEW BLVD
Second Line	:	SUITE C-2
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-6727
Country	:	US
Telephone Number	:	571-289-9729
Fax Number	:

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

Provider Enumeration Date	:	02/03/2010
Last Update Date	:	02/03/2010

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