| Cassandre Moore Lcsw Llc | |
|
671 E Riverpark Ln Ste 100 Boise ID 83706-4000 | |
| (208) 861-7448 | |
| Not Available |
| Full Name | Cassandre Moore Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 671 E Riverpark Ln Ste 100, Boise, Idaho |
| Authorized Official Name and Position | Cassandre Moore (OWNER) |
| Authorized Official Contact | 2088617448 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cassandre Moore Lcsw Llc 999 N Slater Crk Boise ID 83716-5015 Ph: (208) 861-7448 | Cassandre Moore Lcsw Llc 671 E Riverpark Ln Ste 100 Boise ID 83706-4000 Ph: (208) 861-7448 |
| NPI Number | 1053879874 |
|---|---|
| Provider Enumeration Date | 03/11/2019 |
| Last Update Date | 09/21/2020 |
| Certification Date | 09/21/2020 |
| Medicare PECOS PAC ID | 5597175612 |
|---|---|
| Medicare Enrollment ID | O20201101000008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053879874 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Cassandre Lynn Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154667061 PECOS PAC ID: 2961765532 Enrollment ID: I20180412000950 |
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