Provider Demographics
NPI:1568275469
Name:MOORE, WENDEJA (LMSW)
Entity type:Individual
Prefix:
First Name:WENDEJA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 WYOMING BLVD NE STE M4
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1963
Mailing Address - Country:US
Mailing Address - Phone:505-990-8576
Mailing Address - Fax:
Practice Address - Street 1:7441 BARTLETT ST NE STE 1C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5916
Practice Address - Country:US
Practice Address - Phone:505-990-8576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker