Provider Demographics
NPI:1497165591
Name:MOORE, KAREN (LCSW, CEDS-S)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW, CEDS-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 SE FEDERAL HWY STE 206
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3842
Mailing Address - Country:US
Mailing Address - Phone:772-212-2935
Mailing Address - Fax:
Practice Address - Street 1:1111 SE FEDERAL HWY STE 206
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3842
Practice Address - Country:US
Practice Address - Phone:772-212-2935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 77901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical