Provider Demographics
NPI:1407905813
Name:MOORE, ROBERT CAYTON (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CAYTON
Last Name:MOORE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2489 COUNTY HOME RD
Mailing Address - Street 2:APT 180
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-9641
Mailing Address - Country:US
Mailing Address - Phone:252-916-7157
Mailing Address - Fax:919-751-0890
Practice Address - Street 1:1208 PARKWAY DR STE C
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9432
Practice Address - Country:US
Practice Address - Phone:919-751-8444
Practice Address - Fax:919-751-0890
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0012551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2869597Medicare ID - Type UnspecifiedLCSW