Provider Demographics
NPI:1013983972
Name:MOORE, WILLIAM EDWARD (MSW, LSCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:MOORE
Suffix:
Gender:M
Credentials:MSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 SW 28TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2302
Mailing Address - Country:US
Mailing Address - Phone:785-228-1968
Mailing Address - Fax:785-273-6249
Practice Address - Street 1:5040 SW 28TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2302
Practice Address - Country:US
Practice Address - Phone:785-228-1968
Practice Address - Fax:785-273-6249
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS069408Medicare ID - Type Unspecified
KSR31160Medicare UPIN