MEDICARE: JAMAAL MOORE LMSW

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	1041S0200X	School Social Worker	X-07138	NM

General Provider Information

NPI Number	:	1376853119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMAAL MOORE LMSW

Provider Business Mailing Address
First Line	:	4501 MORRIS ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3790
Country	:	US
Telephone Number	:	757-450-9804
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 MORRIS ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3790
Country	:	US
Telephone Number	:	757-450-9804
Fax Number	:

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

Provider Enumeration Date	:	10/14/2010
Last Update Date	:	10/14/2010

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