MEDICARE: CHELSEA MOORE MS, BCBA, LBA

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	103K00000X	Behavior Analyst	1-18-31254	VA

General Provider Information

NPI Number	:	1376090548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA MOORE MS, BCBA, LBA

Provider Business Mailing Address
First Line	:	1500 S DOUGLAS RD STE 230
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4108
Country	:	US
Telephone Number	:	844-854-1116
Fax Number	:

Provider Business Practice Location Address
First Line	:	3855 CENTERVIEW DR STE 400B
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20151-3285
Country	:	US
Telephone Number	:	844-854-1116
Fax Number	:

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

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	09/21/2022

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