Provider Demographics
NPI:1710662523
Name:MOORE, BROOKE KATHRYN (MSW)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:KATHRYN
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33712 WESCOATS RD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4926
Mailing Address - Country:US
Mailing Address - Phone:302-762-2283
Mailing Address - Fax:
Practice Address - Street 1:33712 WESCOATS RD UNIT 4
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4926
Practice Address - Country:US
Practice Address - Phone:302-762-2283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health