Provider Demographics
NPI:1831765841
Name:MOORE, CYNTHIA SUE (MSSA, LSW, CDCA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SUE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSSA, LSW, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16788 STATE ROUTE 62
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:OH
Mailing Address - Zip Code:44609-9268
Mailing Address - Country:US
Mailing Address - Phone:330-206-7040
Mailing Address - Fax:
Practice Address - Street 1:16788 STATE ROUTE 62
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:OH
Practice Address - Zip Code:44609-9268
Practice Address - Country:US
Practice Address - Phone:330-206-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.171707101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)