Provider Demographics
NPI:1801133426
Name:MOORE, CHERYL R
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:R
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 S FREDERICK ST
Mailing Address - Street 2:SUITE 905
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4034
Mailing Address - Country:US
Mailing Address - Phone:410-327-6503
Mailing Address - Fax:410-327-6825
Practice Address - Street 1:3 S FREDERICK ST
Practice Address - Street 2:SUITE 905
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4034
Practice Address - Country:US
Practice Address - Phone:410-327-6503
Practice Address - Fax:410-327-6825
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15440101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health