Provider Demographics
NPI:1164828950
Name:MOORE, NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
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 1:18831 E 58TH AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-8353
Mailing Address - Country:US
Mailing Address - Phone:720-641-3031
Mailing Address - Fax:
Practice Address - Street 1:18831 E 58TH AVE
Practice Address - Street 2:UNIT C
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-8353
Practice Address - Country:US
Practice Address - Phone:720-641-3031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099237191041C0700X
CO1319971041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool