Provider Demographics
NPI:1811220262
Name:MOORE, KRISTEN MARIE PAULSEN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE PAULSEN
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10820 JUSTICE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6222
Mailing Address - Country:US
Mailing Address - Phone:916-543-7429
Mailing Address - Fax:
Practice Address - Street 1:10820 JUSTICE CENTER DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6222
Practice Address - Country:US
Practice Address - Phone:916-543-7429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225C00000X, 225400000X
CA69936104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner