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NPI Code Detail

MEDICARE: JENNIFER C MOORE MSW LCSW INC

MEDICARE: JENNIFER C MOORE MSW LCSW INC
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
11041C0700XClinical Social Worker2948CNV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225280969
Entity Type Code : Organization
Provider Name (Legal Business Name) : JENNIFER C MOORE MSW LCSW INC
Provider Business Mailing Address
First Line : PO BOX 370763
Second Line :
City : LAS VEGAS
State : NV
Zip : 89137-0763
Country : US
Telephone Number : 702-691-1920
Fax Number : 702-240-6970
Provider Business Practice Location Address
First Line : 7180 CASCADE VALLEY CT STE 200
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0481
Country : US
Telephone Number : 702-240-8639
Fax Number : 702-240-6970
Authorized Official
Title or Position : PRESIDENT
Name : MRS. JENNIFER CLAIRE MOORE
Credential : LCSW
Telephone Number : 702-240-8639
Provider Enumeration Date : 10/14/2008
Last Update Date : 12/28/2020

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