Provider Demographics
NPI:1548804297
Name:MOORE SIMPSON, ELIZABETH MARGARET (LICSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARGARET
Last Name:MOORE SIMPSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 BURKE AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6834
Mailing Address - Country:US
Mailing Address - Phone:206-491-9439
Mailing Address - Fax:
Practice Address - Street 1:2311 N 45TH ST # 239
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6905
Practice Address - Country:US
Practice Address - Phone:206-491-9439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
WALW615399041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker