Provider Demographics
NPI:1477015675
Name:MOORE, RONIEKA SHARAE (LMSW)
Entity Type:Individual
Prefix:
First Name:RONIEKA
Middle Name:SHARAE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 REGATTA BAY CT APT 406
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-6282
Mailing Address - Country:US
Mailing Address - Phone:443-221-9434
Mailing Address - Fax:
Practice Address - Street 1:839 BESTGATE RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3472
Practice Address - Country:US
Practice Address - Phone:410-222-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24067104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker