Provider Demographics
NPI:1497501829
Name:MOORE, MADISON TAYLOR (MSW)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:TAYLOR
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 9TH ST STE F
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-2176
Mailing Address - Country:US
Mailing Address - Phone:304-485-0791
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH ST STE F
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-2176
Practice Address - Country:US
Practice Address - Phone:304-485-0791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP009469251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical