Individual provider Active NPI

Laura J Moore, MSW, LCSW

  • Clinical Social Worker
  • Saint Joseph, MO
National Provider Identifier
1104122035
Registry record updated Nov 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2010042642 Issued in MO
Practice address
3608 Faraon St
Saint Joseph, MO 64506-3044
Phone
(816) 232-4417
Fax
(816) 671-0961
NPI assigned
Feb 10, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2010042642 MO Primary

Addresses

Primary practice location

3608 Faraon St
Saint Joseph, MO 64506-3044

Mailing address

2303 Village Dr
Saint Joseph, MO 64506-4954
Phone (816) 232-6818

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211018002181 MO Practitioner - Clinical Social Worker 8022416395 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Health Services Inc Current Accepting new patients
Northwest Health Services, Inc. Clinical CurrentSince Oct 11, 2021 Accepting new patients
Northwest Health Services Inc CurrentSince Oct 11, 2021 Accepting new patients
Catholic Charities of Kansas City-St. Joseph, Inc. Clinical Past Accepting new patients
Catholic Charities of Kansas City-St. Joseph, Inc. Clinical Past Accepting new patients
Northwest Health Services, Inc Clinical Past Accepting new patients

Locations

2303 Village Dr
Saint Joseph, MO 64506
Phone (816) 232-6818

3608 Faraon St
Saint Joseph, MO 64506
Phone (816) 232-4417

1000 5th Ave
Saint Joseph, MO 64505
Phone (816) 233-3338

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636502400000",
    "number": "1104122035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2303 VILLAGE DR",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645064954",
            "telephone_number": "816-232-6818",
            "fax_number": "816-671-0961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3608 FARAON ST",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645063044",
            "telephone_number": "816-232-4417",
            "fax_number": "816-671-0961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "LAURA",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-10",
        "last_updated": "2021-11-10",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2010042642",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MO

Sources for this page

Verify at the official NPI Registry.