MEDICARE: MS. ANGELA M 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	03967	MD

General Provider Information

NPI Number	:	1215006184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA M MOORE MSW

Provider Business Mailing Address
First Line	:	3720 FARRAGUT AVE STE 103
Second Line	:
City	:	KENSINGTON
State	:	MD
Zip	:	20895-2110
Country	:	US
Telephone Number	:	301-929-7932
Fax Number	:

Provider Business Practice Location Address
First Line	:	3720 FARRAGUT AVE STE 103
Second Line	:
City	:	KENSINGTON
State	:	MD
Zip	:	20895-2110
Country	:	US
Telephone Number	:	301-929-7932
Fax Number	:

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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