Provider Demographics
NPI:1720594377
Name:MOORE-JENKINS, CARDETHIA D (LCSW)
Entity Type:Individual
Prefix:
First Name:CARDETHIA
Middle Name:D
Last Name:MOORE-JENKINS
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 1:1 EXCHANGE PL STE 3
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1530
Mailing Address - Country:US
Mailing Address - Phone:508-799-5900
Mailing Address - Fax:855-243-1119
Practice Address - Street 1:1 EXCHANGE PL STE 3
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1530
Practice Address - Country:US
Practice Address - Phone:508-799-5900
Practice Address - Fax:855-243-1119
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2212751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical