Provider Demographics
NPI:1528311404
Name:MOORE, CAROLINE (PHD, LCSW)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 LE ROY AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1116
Mailing Address - Country:US
Mailing Address - Phone:602-430-8306
Mailing Address - Fax:917-591-7417
Practice Address - Street 1:1718 LE ROY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-1116
Practice Address - Country:US
Practice Address - Phone:602-430-8306
Practice Address - Fax:917-591-7417
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075903-11041C0700X
CA870331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical