Provider Demographics
NPI:1902837370
Name:MOORE, SHARON RAE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:RAE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 HUMPHREY ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-4825
Mailing Address - Country:US
Mailing Address - Phone:314-401-6724
Mailing Address - Fax:
Practice Address - Street 1:3801 HUMPHREY
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-4825
Practice Address - Country:US
Practice Address - Phone:314-401-6724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001726301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO829504188Medicare ID - Type UnspecifiedPROVIDER NUMBER