Provider Demographics
NPI:1306024898
Name:MOORE, ANGELA MARIA (MA,LSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 29
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402
Mailing Address - Country:US
Mailing Address - Phone:419-352-5387
Mailing Address - Fax:
Practice Address - Street 1:1010 N PROSPECT ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-1335
Practice Address - Country:US
Practice Address - Phone:419-352-5387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS00024283104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker