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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
1104100000XSocial WorkerX-06317NM
2104100000XSocial WorkerM-06972NM
31041C0700XClinical Social WorkerC-07640NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID 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

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