Provider Demographics
NPI:1427044478
Name:MOORS, ELLANA C (ACSW, LCSW, CAP)
Entity Type:Individual
Prefix:
First Name:ELLANA
Middle Name:C
Last Name:MOORS
Suffix:
Gender:F
Credentials:ACSW, LCSW, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 E COLUMBUS DR.
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605
Mailing Address - Country:US
Mailing Address - Phone:863-519-0575
Mailing Address - Fax:863-534-7028
Practice Address - Street 1:1463 OAKFIELD DR.
Practice Address - Street 2:SUITE 113
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:863-248-3300
Practice Address - Fax:863-534-7028
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW5385104100000X
FL2126L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070869100Medicaid
FL216576000OtherMAGELLAN
FLZ2789OtherBCBS
FLZ2789ZMedicare ID - Type Unspecified