Individual
MRS. CAROLYN MAE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Contact information
Practice address
1600 S MAIN ST, LEBANON, OR 97355-3109
(541) 451-5932
Mailing address
PO BOX 100, ALBANY, OR 97321-0031
(541) 451-5932
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L4204
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500612327
—
OR
Enumeration date
01/20/2006
Last updated
03/05/2018
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