Antionette C Moore, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

79025 Issued in CA

Practice address

5715 Utah TRL
Twentynine Palms, CA 92277-6917

Phone

(760) 367-0730

Fax

(760) 367-0728

NPI assigned

Oct 7, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1412640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539820800000",
    "number": "1881097699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1209",
            "city": "TWENTYNINE PALMS",
            "state": "CA",
            "postal_code": "922770980",
            "telephone_number": "760-367-0730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5715 UTAH TRL",
            "city": "TWENTYNINE PALMS",
            "state": "CA",
            "postal_code": "922776917",
            "telephone_number": "760-367-0730",
            "fax_number": "760-367-0728"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3625 14th St",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925013815",
            "country_code": "US",
            "telephone_number": "951-955-1560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "ANTIONETTE",
        "middle_name": "C",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-07",
        "last_updated": "2018-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "79025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Twentynine Palms, CA
• Providers in Twentynine Palms, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.