Provider Demographics
NPI:1184879389
Name:MOORE, SARAH EMILY (LSW)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:EMILY
Last Name:MOORE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADAMSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16110-1836
Mailing Address - Country:US
Mailing Address - Phone:814-573-2491
Mailing Address - Fax:
Practice Address - Street 1:11488 STATE HWY 98
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-7304
Practice Address - Country:US
Practice Address - Phone:814-573-2491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW127107104100000X
OHS.0600335104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker