MEDICARE: ANTONIA 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	35520	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	219965	OTHER	TX	COMPSYCH, MENTAL HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477625580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTONIA MOORE

Provider Business Mailing Address
First Line	:	3014 HAVERLING DR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-9159
Country	:	US
Telephone Number	:	713-349-9796
Fax Number	:	877-594-6465

Provider Business Practice Location Address
First Line	:	7505 FANNIN ST
Second Line	:	STE 310
City	:	HOUSTON
State	:	TX
Zip	:	77054-1945
Country	:	US
Telephone Number	:	713-349-9796
Fax Number	:	877-594-6465

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MRS. ANTONIA W. MOORE
Credential	:	LCSW
Telephone Number	:	713-349-9796

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	09/11/2015

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Directions to “ANTONIA MOORE ” Practice Location

Language	Start Address	Practice Location

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