Provider Demographics
NPI:1881725802
Name:MOORE, SANDRA EVETTE (MSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:EVETTE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 LESH CT
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-3221
Mailing Address - Country:US
Mailing Address - Phone:410-721-0259
Mailing Address - Fax:410-721-0259
Practice Address - Street 1:2506 LESH CT
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-3221
Practice Address - Country:US
Practice Address - Phone:410-721-0259
Practice Address - Fax:410-721-0259
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker