Provider Demographics
NPI:1942086087
Name:MOORE, TERRENCE PATRICK (LMSW)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:PATRICK
Last Name:MOORE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13817 SADDLEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3853
Mailing Address - Country:US
Mailing Address - Phone:240-477-3022
Mailing Address - Fax:
Practice Address - Street 1:4500 BLACK ROCK RD STE 103
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-2649
Practice Address - Country:US
Practice Address - Phone:877-806-1501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD31606104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program