Provider Demographics
NPI:1649994278
Name:MOORE, SARAH ANN (LMSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
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 1:7421 W COLEHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8435
Mailing Address - Country:US
Mailing Address - Phone:602-743-8561
Mailing Address - Fax:
Practice Address - Street 1:7421 W COLEHAVEN AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8435
Practice Address - Country:US
Practice Address - Phone:602-743-8561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID398391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical