Provider Demographics
NPI:1205088267
Name:GATES-MOORE, KATHERINE J (LCSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:GATES-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 1:106 BLUEBIRD LN
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:PA
Mailing Address - Zip Code:16841-2710
Mailing Address - Country:US
Mailing Address - Phone:814-599-4124
Mailing Address - Fax:
Practice Address - Street 1:2023 CATO AVE STE 101
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2765
Practice Address - Country:US
Practice Address - Phone:814-308-8375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0171931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical