Provider Demographics
NPI:1033893052
Name:MOORE HOLZHAUER, VICKI (LISW-S)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:
Last Name:MOORE HOLZHAUER
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2076 S BELVOIR BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3710
Mailing Address - Country:US
Mailing Address - Phone:216-772-7161
Mailing Address - Fax:
Practice Address - Street 1:2076 S BELVOIR BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3710
Practice Address - Country:US
Practice Address - Phone:216-772-7161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.18010181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical