Provider Demographics
NPI:1346558376
Name:MORIARTY-EDGEWOOD SCHOOL DISTRICT
Entity Type:Organization
Organization Name:MORIARTY-EDGEWOOD SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL SOCAIL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMAAL
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:757-450-9804
Mailing Address - Street 1:4501 MORRIS ST NE
Mailing Address - Street 2:APT 2117
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3790
Mailing Address - Country:US
Mailing Address - Phone:757-450-9804
Mailing Address - Fax:
Practice Address - Street 1:200 CENTER DR.
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87035
Practice Address - Country:US
Practice Address - Phone:505-832-5817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-07138251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health