Provider Demographics
NPI:1033968474
Name:MOORE, TIANNA RAQUEL (MHC-LP)
Entity type:Individual
Prefix:MS
First Name:TIANNA
Middle Name:RAQUEL
Last Name:MOORE
Suffix:
Gender:F
Credentials:MHC-LP
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 1342
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11582-1342
Mailing Address - Country:US
Mailing Address - Phone:347-998-0824
Mailing Address - Fax:
Practice Address - Street 1:1720 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6456
Practice Address - Country:US
Practice Address - Phone:347-973-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)