Provider Demographics
NPI:1164866109
Name:MOORE, PAULA JANE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:JANE
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 1:2465 SOUTH DOWNING ST.
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2465 S DOWNING ST
Practice Address - Street 2:SUITE 110
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5822
Practice Address - Country:US
Practice Address - Phone:303-778-1955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00000572101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health