Provider Demographics
NPI:1881725802
Name:MOORE, SANDRA EVETTE (LGSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:EVETTE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 CLAIRTON ST
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-7004
Mailing Address - Country:US
Mailing Address - Phone:410-980-9402
Mailing Address - Fax:301-374-9188
Practice Address - Street 1:3640 CLAIRTON ST
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-7004
Practice Address - Country:US
Practice Address - Phone:410-980-9402
Practice Address - Fax:301-374-9188
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG200004261104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator