Provider Demographics
NPI:1508649237
Name:MOORE, MAHOGANY M
Entity Type:Individual
Prefix:
First Name:MAHOGANY
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 TRADERS WAY # 40305
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2779
Mailing Address - Country:US
Mailing Address - Phone:409-998-4219
Mailing Address - Fax:
Practice Address - Street 1:45 TRADERS WAY # 40305
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2779
Practice Address - Country:US
Practice Address - Phone:409-998-4219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker