Provider Demographics
NPI:1225280969
Name:JENNIFER C MOORE MSW LCSW INC
Entity Type:Organization
Organization Name:JENNIFER C MOORE MSW LCSW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-240-8639
Mailing Address - Street 1:PO BOX 370763
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-0763
Mailing Address - Country:US
Mailing Address - Phone:702-691-1920
Mailing Address - Fax:702-240-6970
Practice Address - Street 1:7180 CASCADE VALLEY CT STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0481
Practice Address - Country:US
Practice Address - Phone:702-240-8639
Practice Address - Fax:702-240-6970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2948C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100511332Medicaid
NVP75142Medicare UPIN
NVV37026Medicare PIN