Active NPI
Dawnyel Moore, CSW
- Clinical Social Worker
- South Bend, IN
National Provider Identifier
1255972147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 5156
- Practice address
- 220 W Colfax Ave
South Bend, IN 46601-1695 - Phone
- (574) 546-1900
- Fax
- (574) 248-4074
- NPI assigned
- Oct 2, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 5156 | KY | Primary |
Addresses
Primary practice location
220 W Colfax Ave
South Bend, IN 46601-1695
Mailing address
220 W Colfax Ave
South Bend, IN 46601-1695
Phone (574) 546-1900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5156 | KY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569974400000",
"number": "1255972147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 W COLFAX AVE",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466011695",
"telephone_number": "574-546-1900",
"fax_number": "574-248-4074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 W COLFAX AVE",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466011695",
"telephone_number": "574-546-1900",
"fax_number": "574-248-4074"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "DAWNYEL",
"credential": "CSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-10-02",
"last_updated": "2019-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "KY",
"license": "5156",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.