MEDICARE: LIANI LUISA MOORE MSW

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	LICSW1143055	MA
2	1041C0700X	Clinical Social Worker	CSW03305	RI

General Provider Information

NPI Number	:	1962805960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANI LUISA MOORE MSW

Provider Business Mailing Address
First Line	:	117 ELLENFIELD ST STE 101
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02905-4541
Country	:	US
Telephone Number	:	401-444-6777
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 BACON ST
Second Line	:
City	:	PAWTUCKET
State	:	RI
Zip	:	02860-5542
Country	:	US
Telephone Number	:	401-722-3560
Fax Number	:

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

Provider Enumeration Date	:	10/03/2014
Last Update Date	:	01/23/2026

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