Provider Demographics
NPI:1942872486
Name:MOORE, SIOBHAN M (LCSW)
Entity type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ROCK-O-DUNDEE DRIVE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04270
Mailing Address - Country:US
Mailing Address - Phone:207-418-4101
Mailing Address - Fax:
Practice Address - Street 1:17 GARY ST
Practice Address - Street 2:
Practice Address - City:SOUTH PARIS
Practice Address - State:ME
Practice Address - Zip Code:04281-1636
Practice Address - Country:US
Practice Address - Phone:207-418-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2025-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC250881041C0700X
MELC8240101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)