Provider Demographics
NPI:1700168424
Name:MOORE, PATRICIA ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:2816 BLUEGRASS DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:KY
Mailing Address - Zip Code:41076-1577
Mailing Address - Country:US
Mailing Address - Phone:859-442-8500
Mailing Address - Fax:859-442-8555
Practice Address - Street 1:2816 BLUEGRASS DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:KY
Practice Address - Zip Code:41076-1577
Practice Address - Country:US
Practice Address - Phone:859-442-8500
Practice Address - Fax:859-442-8555
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-33711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical