Provider Demographics
NPI:1669864179
Name:MOORE, JUDY (LMSW)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name: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 1:3000 E 112TH AVE UNIT 70
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4685
Mailing Address - Country:US
Mailing Address - Phone:303-319-2207
Mailing Address - Fax:
Practice Address - Street 1:3000 E 112TH AVE UNIT 70
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-4685
Practice Address - Country:US
Practice Address - Phone:303-319-2207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-21
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW 93981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical