| Stuart Moore Llc | |
|
12050 S Lakes Dr Reston VA 20191-1220 | |
| (703) 386-0050 | |
| Not Available |
| Full Name | Stuart Moore Llc |
|---|---|
| Speciality | Social Worker |
| Location | 12050 S Lakes Dr, Reston, Virginia |
| Authorized Official Name and Position | Stuart Coleman Moore (OWNER) |
| Authorized Official Contact | 7033860050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stuart Moore Llc 12050 S Lakes Dr Reston VA 20191-1220 Ph: (703) 386-0050 | Stuart Moore Llc 12050 S Lakes Dr Reston VA 20191-1220 Ph: (703) 386-0050 |
| NPI Number | 1417440397 |
|---|---|
| Provider Enumeration Date | 06/14/2018 |
| Last Update Date | 06/14/2018 |
| Medicare PECOS PAC ID | 3577803873 |
|---|---|
| Medicare Enrollment ID | O20190325000741 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417440397 | NPI | - | NPPES |
| 1346318763 | Other | VA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 0904003326 (Virginia) | Primary |
| Provider Name | Stuart C Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346318763 PECOS PAC ID: 3971649278 Enrollment ID: I20120406000309 |
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