Provider Demographics
NPI:1508484478
Name:MOORE, TAMIKA (MSSA, LISW)
Entity Type:Individual
Prefix:MRS
First Name:TAMIKA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSSA, LISW
Other - Prefix:MS
Other - First Name:TAMIKA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:20150 LAKE SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1839
Mailing Address - Country:US
Mailing Address - Phone:216-714-2151
Mailing Address - Fax:
Practice Address - Street 1:10524 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-2205
Practice Address - Country:US
Practice Address - Phone:216-844-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker