Provider Demographics
NPI:1477575918
Name:MOORE, MARLA G (LCSW)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:G
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3581 E GLENCOE ST APT 205
Mailing Address - Street 2:
Mailing Address - City:COCONUT GROVE
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4056
Mailing Address - Country:US
Mailing Address - Phone:305-541-5864
Mailing Address - Fax:305-541-8614
Practice Address - Street 1:1492 W FLAGLER ST STE 109
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2209
Practice Address - Country:US
Practice Address - Phone:305-541-5864
Practice Address - Fax:305-541-8614
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040056001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical