Provider Demographics
NPI:1992572507
Name:MOORE, MICHAEL M (LCADC, MSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:M
Last Name:MOORE
Suffix:
Gender:M
Credentials:LCADC, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 PARK ST APT 2
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1116
Mailing Address - Country:US
Mailing Address - Phone:973-380-5339
Mailing Address - Fax:
Practice Address - Street 1:184 PARK ST APT 2
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1116
Practice Address - Country:US
Practice Address - Phone:973-380-5339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00340200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)