Individual
GEORGE J MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1445 SEACREST LN APT 5, BROOKINGS, OR 97415-8133
(315) 876-4419
(315) 635-1865
Mailing address
1445 SEACREST LN APT 5, BROOKINGS, OR 97415-8133
(315) 876-4419
(315) 635-1865
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
080335
NY
1041C0700X
Clinical Social Worker
Primary
082400
NY
1041C0700X
Clinical Social Worker
93051
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02994838
GRP MCD #
NY
01
—
BA1047
GRP MCR #
—
Enumeration date
11/10/2011
Last updated
02/05/2020
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