Provider Demographics
NPI:1568599355
Name:MOORE, KAREN LEA (LCSW-C, L AC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEA
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW-C, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RIDGE RD UNIT F
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2970
Mailing Address - Country:US
Mailing Address - Phone:240-351-8957
Mailing Address - Fax:
Practice Address - Street 1:7935 BELLE POINT DRIVE
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:240-351-8957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD070091041C0700X
MDUO1114171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF7180001Medicare UPIN
MD15890001Medicare UPIN