Provider Demographics
NPI:1245676766
Name:MOORER, TRACIE M (MSW)
Entity type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:M
Last Name:MOORER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:M
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 USHER CIR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-3729
Mailing Address - Country:US
Mailing Address - Phone:850-292-8808
Mailing Address - Fax:
Practice Address - Street 1:2711 W 15TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-1366
Practice Address - Country:US
Practice Address - Phone:850-769-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical