Provider Demographics
NPI:1487930210
Name:MOORE, RONALD CRAIG (MSW)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:CRAIG
Last Name:MOORE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-7203
Mailing Address - Country:US
Mailing Address - Phone:702-525-0088
Mailing Address - Fax:702-380-2893
Practice Address - Street 1:525 S 13TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-7203
Practice Address - Country:US
Practice Address - Phone:702-525-0088
Practice Address - Fax:702-380-2893
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00648101YA0400X
CAASW22325104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)