Provider Demographics
NPI:1083395289
Name:MOORE, JACQUELINE JUNE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:JUNE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 ASHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LITTLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17340-9527
Mailing Address - Country:US
Mailing Address - Phone:410-591-8526
Mailing Address - Fax:
Practice Address - Street 1:43 ASHFIELD DR
Practice Address - Street 2:
Practice Address - City:LITTLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:17340-9527
Practice Address - Country:US
Practice Address - Phone:410-591-8526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD046381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical