Provider Demographics
NPI:1962100958
Name:MOORE, MADELEINE CORY (MS, LIMHP)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:CORY
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 S 39TH ST APT 16
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-3022
Mailing Address - Country:US
Mailing Address - Phone:402-312-7471
Mailing Address - Fax:
Practice Address - Street 1:2439 BURT ST APT 16
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68178-0019
Practice Address - Country:US
Practice Address - Phone:402-280-2256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2369101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health