Provider Demographics
NPI:1750816195
Name:MOE, WARREN DREW
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:DREW
Last Name:MOE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W 28TH ST
Mailing Address - Street 2:SUITE 1803
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6103
Mailing Address - Country:US
Mailing Address - Phone:917-543-8620
Mailing Address - Fax:
Practice Address - Street 1:150 W 28TH ST
Practice Address - Street 2:SUITE 1803
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6103
Practice Address - Country:US
Practice Address - Phone:917-543-8620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9662379101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health