Provider Demographics
NPI:1982816773
Name:MOORE, CATHERINE SUSAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:SUSAN
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 YORK AVENUE
Mailing Address - Street 2:#P7
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2577
Mailing Address - Country:US
Mailing Address - Phone:212-717-6913
Mailing Address - Fax:212-717-8284
Practice Address - Street 1:1440 YORK AVENUE
Practice Address - Street 2:#P7
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2577
Practice Address - Country:US
Practice Address - Phone:212-717-6913
Practice Address - Fax:212-717-8284
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR021375-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52368688OtherUNITED BEHAVIORAL HEALTH
NY109589OtherGHI-VALUE OPTIONS
NY52368688OtherUNITED BEHAVIORAL HEALTH