Provider Demographics
NPI:1548338544
Name:MOON, SHARON B (MSW)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:B
Last Name:MOON
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:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20604-0545
Mailing Address - Country:US
Mailing Address - Phone:301-392-6160
Mailing Address - Fax:301-934-2907
Practice Address - Street 1:11 N MAPLE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-3744
Practice Address - Country:US
Practice Address - Phone:301-870-4075
Practice Address - Fax:301-934-2907
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD57541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQR72Medicare ID - Type UnspecifiedID NUMBER