MEDICARE: JENNIFER C MOORE MSW LCSW INC

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

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	:	1962099572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER C MOORE MSW LCSW INC

Provider Business Mailing Address
First Line	:	PO BOX 370763
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89137-0763
Country	:	US
Telephone Number	:	702-240-8639
Fax Number	:	702-240-6970

Provider Business Practice Location Address
First Line	:	660 S GREEN VALLEY PKWY STE 140-150
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-0430
Country	:	US
Telephone Number	:	702-240-8639
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	JENNIFER C MOORE
Credential	:
Telephone Number	:	702-240-8639

Provider Enumeration Date	:	12/29/2020
Last Update Date	:	01/18/2021

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