Provider Demographics
NPI:1902956816
Name:MOORE, DONNA M (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03302-0363
Mailing Address - Country:US
Mailing Address - Phone:603-229-0300
Mailing Address - Fax:603-229-4599
Practice Address - Street 1:8 UNION ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4249
Practice Address - Country:US
Practice Address - Phone:603-229-0300
Practice Address - Fax:603-229-4599
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010795Medicaid
CT1408008Y0NH01OtherANTHEM
4593602OtherAETNA BEHAVIORAL HEALTH
NH30010795Medicaid