Provider Demographics
NPI:1831555804
Name:MOORE, JAMILLAH J (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JAMILLAH
Middle Name:J
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 1:2410 COPPER MOUNTAIN TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-6228
Mailing Address - Country:US
Mailing Address - Phone:301-337-0042
Mailing Address - Fax:
Practice Address - Street 1:2410 COPPER MOUNTAIN TER
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-6228
Practice Address - Country:US
Practice Address - Phone:301-337-0042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2023-07-06
Deactivation Date:2017-03-01
Deactivation Code:
Reactivation Date:2019-05-01
Provider Licenses
StateLicense IDTaxonomies
DCLC50082119171M00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator