MEDICARE: SHARON MOORE

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	6801060845	MI

General Provider Information

NPI Number	:	1376934281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON MOORE

Provider Business Mailing Address
First Line	:	28835 MURRAY CRESCENT DR
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-5562
Country	:	US
Telephone Number	:	313-768-7761
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 PIQUETTE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3513
Country	:	US
Telephone Number	:	313-575-1580
Fax Number	:

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

Provider Enumeration Date	:	02/13/2015
Last Update Date	:	02/13/2015

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Directions to “ SHARON MOORE ” Practice Location

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