Individual
BERNADETTE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
810 W 45TH ST, AUSTIN, TX 78751-2802
(512) 451-2242
(512) 454-9204
Mailing address
810 W 45TH ST, AUSTIN, TX 78751-2802
(512) 451-2242
(512) 454-9204
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
19728
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86365Q
BLUE CROSS BLUE SHIELD
TX
Enumeration date
04/06/2007
Last updated
07/09/2007
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