Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 34006639A | IN |
NPI | 1003152596 |
---|---|
Provider Name | Thelma Moore |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-2207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2013 |
Last Update Date | 28/01/2022 |