Active NPI
M Susan Moore, LCSW
- Clinical Social Worker
- North Little Rock, AR
National Provider Identifier
1679683189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C-649
- Practice address
- 2200 Fort Roots Dr # 116/NLR
North Little Rock, AR 72114-1709 - Phone
- (501) 257-3147
- Fax
- (501) 257-3182
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
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 | C-649 | AR | Primary |
Addresses
Primary practice location
2200 Fort Roots Dr # 116/NLR
North Little Rock, AR 72114-1709
Mailing address
2200 Fort Roots Dr # 116/NLR
North Little Rock, AR 72114-1709
Phone (501) 257-3147
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2084P0800X | Other | AR | PSYCHIATRY |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C-649 | AR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679683189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 FORT ROOTS DR # 116/NLR",
"city": "NORTH LITTLE ROCK",
"state": "AR",
"postal_code": "721141709",
"telephone_number": "501-257-3147",
"fax_number": "501-257-3182"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 FORT ROOTS DR # 116/NLR",
"city": "NORTH LITTLE ROCK",
"state": "AR",
"postal_code": "721141709",
"telephone_number": "501-257-3147",
"fax_number": "501-257-3182"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "M",
"middle_name": "SUSAN",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AR",
"license": "C-649",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHIATRY",
"identifier": "2084P0800X",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.