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NPI Code Detail

MEDICARE: MRS. MARIA A MOORE ICS

MEDICARE: MRS. MARIA A MOORE ICS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor15585-132WI
2101YA0400XAddiction (Substance Use Disorder) Counselor15431-134WI

General Provider Information

NPI Number : 1174956635
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARIA A MOORE ICS
Provider Business Mailing Address
First Line : 2319 W CAPITOL DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53206-1919
Country : US
Telephone Number : 414-442-2033
Fax Number : 414-442-2167
Provider Business Practice Location Address
First Line : 2319 W CAPITOL DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53206-1919
Country : US
Telephone Number : 414-442-2033
Fax Number : 414-442-2167
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2013
Last Update Date : 03/17/2017

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Directions to “ MRS. MARIA A MOORE ICS” Practice Location

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