Provider Demographics
NPI:1700858412
Name:MOORE, JEANNE MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JEANNE MARIE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2852 WILLAMETTE ST
Mailing Address - Street 2:PMB #103
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-8200
Mailing Address - Country:US
Mailing Address - Phone:541-684-9797
Mailing Address - Fax:541-344-5599
Practice Address - Street 1:5 E 24TH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2907
Practice Address - Country:US
Practice Address - Phone:541-684-9797
Practice Address - Fax:541-344-5599
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL29961041C0700X
CALCS134121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
77459698ZOtherUNITED BEHAVIORAL HEALTH
132182Medicare ID - Type Unspecified