Provider Demographics
NPI:1982977336
Name:MOORE, DEVON MICHELLE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:MICHELLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-2010
Mailing Address - Country:US
Mailing Address - Phone:765-418-6850
Mailing Address - Fax:765-477-7806
Practice Address - Street 1:1530 S 18TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-2010
Practice Address - Country:US
Practice Address - Phone:765-418-6850
Practice Address - Fax:765-477-7806
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33005691A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical