Provider Demographics
NPI:1396041638
Name:MOORE, CHARLETHA
Entity Type:Individual
Prefix:
First Name:CHARLETHA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40849 FREMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-4306
Mailing Address - Country:US
Mailing Address - Phone:510-739-1945
Mailing Address - Fax:510-739-6963
Practice Address - Street 1:40849 FREMONT BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-4306
Practice Address - Country:US
Practice Address - Phone:510-739-1945
Practice Address - Fax:510-739-6963
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker