Provider Demographics
NPI:1619306313
Name:MOORE, LINDA (CDMS, CCM)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:CDMS, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8747 SQUIRES LN NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1649
Mailing Address - Country:US
Mailing Address - Phone:330-841-3702
Mailing Address - Fax:330-841-3541
Practice Address - Street 1:8747 SQUIRES LN NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1649
Practice Address - Country:US
Practice Address - Phone:330-841-3702
Practice Address - Fax:330-841-3541
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$00OtherOHIO BUREAU OF WORKER'S COMPENSATION PROVIDER NUMBER