MEDICARE: MR. MICHAEL T MOORE CASAC-T

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1104615970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL T MOORE CASAC-T

Provider Business Mailing Address
First Line	:	830 FOREST AVE RM 119
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-7802
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 FOREST AVE RM 119
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-7802
Country	:	US
Telephone Number	:	718-742-5684
Fax Number	:

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

Provider Enumeration Date	:	05/06/2025
Last Update Date	:	05/06/2025

Similar Medicare Providers

1255859096 — KENNETH PFEIFFER CASAC
Practice Location Address:

830 FOREST AVE RM 139
BRONX, NY
10456-7802

Practice Phone: 718-742-5684
Practice Fax:

1558094706 — ARGUS COMMUNITY, INC.
Practice Location Address:

830 FOREST AVE FL 234
BRONX, NY
10456-7802

Practice Phone: 718-401-5788
Practice Fax: 929-419-1787

1871289884 — LATOYA GREENE LMSW
Practice Location Address:

830 FOREST AVE
BRONX, NY
10456-7802

Practice Phone: 718-401-5788
Practice Fax:

1841057015 — MS. TAIWO FAUSAT BOLARINWA NURSE
Practice Location Address:

830 FOREST AVE
BRONX, NY
10456-7802

Practice Phone: 718-401-5788
Practice Fax:

1952260713 — SHAVA QUINONES
Practice Location Address:

2846 HEATH AVE
BRONX, NY
10463-7802

Practice Phone: 718-304-3323
Practice Fax:

1417300971 — TERESA VICTORIA QUINONES RN
Practice Location Address:

2846 HEATH AVE
BRONX, NY
10463-7802

Practice Phone: 347-374-1245
Practice Fax:

Directions to “ MR. MICHAEL T MOORE CASAC-T” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.