Provider Demographics
NPI:1295551216
Name:MOORE, JOSEPHINE HIGGINS (LMSW)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:HIGGINS
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:FORT EDWARD
Mailing Address - State:NY
Mailing Address - Zip Code:12828-9217
Mailing Address - Country:US
Mailing Address - Phone:518-760-3476
Mailing Address - Fax:
Practice Address - Street 1:46 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828-9217
Practice Address - Country:US
Practice Address - Phone:518-760-3476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116343104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker