Provider Demographics
NPI:1841776697
Name:PATIENCE MOORE, LCSW, LLC
Entity Type:Organization
Organization Name:PATIENCE MOORE, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATIENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-907-4755
Mailing Address - Street 1:460 BLOOMFIELD AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3552
Mailing Address - Country:US
Mailing Address - Phone:973-907-4755
Mailing Address - Fax:
Practice Address - Street 1:460 BLOOMFIELD AVE STE 306
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3552
Practice Address - Country:US
Practice Address - Phone:973-907-4755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056419001041C0700X, 251S00000X
NJ44SC05411900251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health