Provider Demographics
NPI:1831662089
Name:MOORE, PATRICK EVAN (LSW)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:EVAN
Last Name:MOORE
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 LOCKBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-2597
Mailing Address - Country:US
Mailing Address - Phone:220-465-5320
Mailing Address - Fax:
Practice Address - Street 1:2565 LOCKBOURNE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-2597
Practice Address - Country:US
Practice Address - Phone:220-465-5320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1802002104100000X
OHI.23044311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker