Provider Demographics
NPI:1053414102
Name:MOORE, THOMAS (LCSW)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 8TH AVE
Mailing Address - Street 2:SUITE 709
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5126
Mailing Address - Country:US
Mailing Address - Phone:212-691-4408
Mailing Address - Fax:212-691-4982
Practice Address - Street 1:80 8TH AVE
Practice Address - Street 2:SUITE 709
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5126
Practice Address - Country:US
Practice Address - Phone:212-691-4408
Practice Address - Fax:212-691-4982
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR037112-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical