Provider Demographics
NPI:1073601696
Name:MOORE, ROSEMARY BROWN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:BROWN
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VAMC-116A6
Mailing Address - Street 2:ONE VETERANS DRIVE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417
Mailing Address - Country:US
Mailing Address - Phone:612-467-4607
Mailing Address - Fax:612-727-5633
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:VAMC-116A6
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-4607
Practice Address - Fax:612-727-5633
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical