Provider Demographics
NPI:1750151825
Name:MOORE, JACQUELINE ARMSTRONG (LCSW)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ARMSTRONG
Last Name: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 1:4800 S MACADAM AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3927
Mailing Address - Country:US
Mailing Address - Phone:518-570-0149
Mailing Address - Fax:
Practice Address - Street 1:4800 S MACADAM AVE STE 230
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3927
Practice Address - Country:US
Practice Address - Phone:971-266-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL116321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical