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1407005796

NPI Code Detail

MEDICARE: ELISABETH ANN MOORE LISW

MEDICARE: ELISABETH ANN MOORE LISW

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	104100000X	Social Worker	X-06317	NM
2	104100000X	Social Worker	M-06972	NM
3	1041C0700X	Clinical Social Worker	C-07640	NM

Other Identifiers

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

General Provider Information

NPI Number	:	1407005796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISABETH ANN MOORE LISW

Provider Business Mailing Address
First Line	:	PO BOX 3141
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88221-3141
Country	:	US
Telephone Number	:	575-725-5552
Fax Number	:	575-725-5552

Provider Business Practice Location Address
First Line	:	1900 WESTRIDGE RD
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88220-3550
Country	:	US
Telephone Number	:	575-725-5552
Fax Number	:	575-725-5552

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

Provider Enumeration Date	:	09/11/2008
Last Update Date	:	03/19/2025

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Directions to “ ELISABETH ANN MOORE LISW” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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