Provider Demographics
NPI:1568170025
Name:JONES-MOORE, CHEVELLE (LMSW)
Entity Type:Individual
Prefix:
First Name:CHEVELLE
Middle Name:
Last Name:JONES-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:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-0014
Mailing Address - Country:US
Mailing Address - Phone:315-720-6428
Mailing Address - Fax:
Practice Address - Street 1:1453 S STATE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-1137
Practice Address - Country:US
Practice Address - Phone:315-720-6428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052617-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker