Provider Demographics
NPI:1780829234
Name:MOORE, ROSIE CALICCHIO (MED)
Entity Type:Individual
Prefix:MS
First Name:ROSIE
Middle Name:CALICCHIO
Last Name:MOORE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-6025
Mailing Address - Country:US
Mailing Address - Phone:206-860-0480
Mailing Address - Fax:206-860-0680
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:OBCC
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-860-0480
Practice Address - Fax:206-860-0680
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00009312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health