Provider Demographics
NPI:1578202255
Name:MOORE, ELIZABETH A (LISW-S)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2256 ROHRER ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-5745
Mailing Address - Country:US
Mailing Address - Phone:330-718-3225
Mailing Address - Fax:
Practice Address - Street 1:2256 ROHRER ST NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-5745
Practice Address - Country:US
Practice Address - Phone:330-718-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1901501-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical