Provider Demographics
NPI:1023133741
Name:MOORE, BARBARA A (LCSW)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
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 1:12717 S PEORIA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-6638
Mailing Address - Country:US
Mailing Address - Phone:708-532-6951
Mailing Address - Fax:708-532-6952
Practice Address - Street 1:12717 S PEORIA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-6638
Practice Address - Country:US
Practice Address - Phone:708-532-6951
Practice Address - Fax:708-532-6952
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical