Marshelle Katherine Moore, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW6379 Issued in FL

Practice address

620 NW 16TH Ave
Gainesville, FL 32601-4034

Phone

(352) 376-8788

NPI assigned

Nov 14, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Miss Marshelle Katherine Ponce Former name

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical

  Medicare reassignment NPD

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194998400000",
    "number": "1255512612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 NW 16TH AVE",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326014034",
            "telephone_number": "352-376-8788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 NW 16TH AVE",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326014034",
            "telephone_number": "352-376-8788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARSHELLE",
        "middle_name": "KATHERINE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-14",
        "last_updated": "2007-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW6379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW",
            "identifier": "SW6379",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARSHELLE",
            "last_name": "PONCE",
            "middle_name": "KATHERINE",
            "prefix": "MISS",
            "credential": "MSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kathryn Pax Lattimore Moore, M.D.
• Kendall Dee Moore, M.D.
• Kenya Moore
• Kevin Moore
• Lucie Moore
• Matthew Macahan Moore
• Michael Moore
• Natalie Moore, LMHC
• Pamela Susan Moore, APRN
• Rachael Frances Moore, PHARMD

• Clinical Social Worker in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.