Individual
ELLEN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3282 ADELINE ST, BERKELEY, CA 94703-2439
(510) 981-5280
Mailing address
2972 OTIS ST, BERKELEY, CA 94703-2517
(510) 841-2959
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LCS17591
CA
Other
Enumeration date
07/04/2006
Last updated
07/08/2007
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