Provider Demographics
NPI:1336774769
Name:MOORE, DELORES A (RSW)
Entity Type:Individual
Prefix:MRS
First Name:DELORES
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12711 TEAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-4812
Mailing Address - Country:US
Mailing Address - Phone:225-301-7673
Mailing Address - Fax:
Practice Address - Street 1:12711 TEAKWOOD DR
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-4812
Practice Address - Country:US
Practice Address - Phone:225-301-7673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator