Provider Demographics
NPI:1184762486
Name:MOORE, DORIS LOUISE (PHD, MSW, RAS)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:LOUISE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD, MSW, RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 DERBY STREET
Mailing Address - Street 2:#214
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1973
Mailing Address - Country:US
Mailing Address - Phone:510-529-4506
Mailing Address - Fax:
Practice Address - Street 1:25 ALLEN STREET
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-1513
Practice Address - Country:US
Practice Address - Phone:925-313-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1184762486Medicaid