Latrease R Moore, LMHC is a medicare enrolled "Psychologist - Clinical" provider in Utica, New York. Her current practice location is
1612 Genesee St, Utica, New York. You can reach out to her office (for appointments etc.) via phone at
(315) 724-5173.
Latrease R Moore is licensed to practice in New York (license number 024435-01) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1497114920.
Healthcare Provider's Profile
Full Name | Latrease R Moore |
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Gender | Female |
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Speciality | Psychologist - Clinical |
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Location | 1612 Genesee St, Utica, New York |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1497114920
- Provider Enumeration Date: 02/11/2016
- Last Update Date: 12/01/2021
Medicare PECOS Information:
- PECOS PAC ID: 7618367566
- Enrollment ID: I20211208000548
Medical Identifiers
Medical identifiers for Latrease R Moore such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1497114920 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
101YM0800X | Counselor - Mental Health | 005071 (New York) | Secondary |
103TC0700X | Psychologist - Clinical | 024435-01 (New York) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Latrease R Moore allows following entities to bill medicare on her behalf.
Entity Name | Samaritan Counseling Center Of The Mohawk Valley, Inc. |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1649377854 PECOS PAC ID: 8921083882 Enrollment ID: O20040623001086 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Latrease R Moore is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Latrease R Moore, LMHC 1612 Genesee St, Utica, NY 13502-5425 Ph: (315) 724-5173 | Latrease R Moore, LMHC 1612 Genesee St, Utica, NY 13502-5425 Ph: (315) 724-5173 |
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