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Individual
PENELOPE ANNE MOORE
Active
Individual
PENELOPE ANNE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA MED MSW LICSW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
1801
MA
1041C0700X
Clinical Social Worker
Primary
120302
MA
1041C0700X
Clinical Social Worker
217592
MA
106H00000X
Marriage & Family Therapist
939
MA
Other
Enumeration date
01/30/2007
Last updated
06/16/2017
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