MEDICARE: MRS. PAMELLA JOYCE MOORE 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	PIP354-1148C	AL

General Provider Information

NPI Number	:	1346323268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELLA JOYCE MOORE LCSW

Provider Business Mailing Address
First Line	:	4126 AUTUMN LN
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-5209
Country	:	US
Telephone Number	:	205-967-3277
Fax Number	:	205-967-3352

Provider Business Practice Location Address
First Line	:	4126 AUTUMN LN
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-5209
Country	:	US
Telephone Number	:	205-967-3277
Fax Number	:	205-967-3352

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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