Provider Demographics
NPI:1982078317
Name:MOORE, ROB (PHD, MSW, MSP, CADC)
Entity Type:Individual
Prefix:
First Name:ROB
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHD, MSW, MSP, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 LA CUEVA WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5415
Mailing Address - Country:US
Mailing Address - Phone:916-662-6809
Mailing Address - Fax:
Practice Address - Street 1:7000 FRANKLIN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1865
Practice Address - Country:US
Practice Address - Phone:916-662-6809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health