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NPI Code Detail

MEDICARE: CATHERINE MOORE PCC

MEDICARE: CATHERINE MOORE PCC
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
1101YP2500XProfessional CounselorE-0002423OH

General Provider Information

NPI Number : 1568898427
Entity Type Code : Individual
Provider Name (Legal Business Name) : CATHERINE MOORE PCC
Provider Business Mailing Address
First Line : 4532 MACKALL RD
Second Line :
City : SOUTH EUCLID
State : OH
Zip : 44121-4240
Country : US
Telephone Number : 216-385-9653
Fax Number :
Provider Business Practice Location Address
First Line : 23293 COMMERCE PARK
Second Line :
City : BEACHWOOD
State : OH
Zip : 44122-5808
Country : US
Telephone Number : 216-385-9653
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2013
Last Update Date : 09/23/2013

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