Provider Demographics
NPI:1760710966
Name:MOORE, TINA (LSW)
Entity Type:Individual
Prefix:MISS
First Name:TINA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 ELMWOOD RD
Mailing Address - Street 2:APT. A
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-3405
Mailing Address - Country:US
Mailing Address - Phone:717-471-0812
Mailing Address - Fax:
Practice Address - Street 1:1681 CROWN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6303
Practice Address - Country:US
Practice Address - Phone:717-399-3213
Practice Address - Fax:717-399-3543
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-27
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA208367317OtherQUEST BEHAVIORAL HEALTH
PA208367317OtherEDUCATORS HEALTH PARTNERS
PA208367317OtherHEALTH ASSURANCE
PA208367317OtherCAPITAL BLUE CROSS