Provider Demographics
NPI:1790331528
Name:MOORE, PAULA JOANN (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:JOANN
Last Name:MOORE
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Gender:F
Credentials:MSW, LCSW
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Mailing Address - Street 1:PAULA J MOORE, LCSW
Mailing Address - Street 2:200 W. 3RD ST, SUITE 410
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6182
Mailing Address - Country:US
Mailing Address - Phone:314-252-8446
Mailing Address - Fax:888-585-3941
Practice Address - Street 1:PAULA J MOORE, LCSW
Practice Address - Street 2:200 W. 3RD ST, SUITE 410
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6182
Practice Address - Country:US
Practice Address - Phone:314-252-8446
Practice Address - Fax:888-585-3941
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20170315341041C0700X
IL1490225551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty