Provider Demographics
NPI:1497400436
Name:MOORE, SHIMENA RENAE (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:SHIMENA
Middle Name:RENAE
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 1:222 KYSER BLVD APT 9
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2305
Mailing Address - Country:US
Mailing Address - Phone:256-541-0947
Mailing Address - Fax:
Practice Address - Street 1:500 MARKAVIEW RD NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-3652
Practice Address - Country:US
Practice Address - Phone:256-535-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3220G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker