Provider Demographics
NPI:1033127097
Name:MOORE, VICKY LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:LYNN
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BIRNENSTEIG 1
Mailing Address - Street 2:
Mailing Address - City:AMBERG
Mailing Address - State:BAVARIA
Mailing Address - Zip Code:92224
Mailing Address - Country:DE
Mailing Address - Phone:0962-132-0968
Mailing Address - Fax:
Practice Address - Street 1:USA MEDDAC BAVARIA
Practice Address - Street 2:UNIT 26610
Practice Address - City:APO
Practice Address - State:BAVARIA
Practice Address - Zip Code:09112
Practice Address - Country:DE
Practice Address - Phone:0966-283-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical