Basic Information
| Provider Information | |||||||||
| NPI: | 1457638694 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 S EDWIN C MOSES BLVD | ||||||||
| Address2: | 1ST FLOOR, NW BUILDING | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454173424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372244646 | ||||||||
| FaxNumber: | 9372768269 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 S EDWIN C MOSES BLVD | ||||||||
| Address2: | 1ST FLOOR, NW BUILDING | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454173424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372244646 | ||||||||
| FaxNumber: | 9372768269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2011 | ||||||||
| LastUpdateDate: | 11/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S0004272 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.