Individual provider Active NPI

Carolyn Mercedes Moore, MSW, LCSW

  • Clinical Social Worker
  • Tampa, FL
National Provider Identifier
1922699602
Registry record updated Sep 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW16965 Issued in FL
Practice address
4700 N Habana Ave Ste 703
Tampa, FL 33614-7122
Phone
(941) 499-0463
NPI assigned
Jan 27, 2021
Last updated
Sep 22, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 16965 FL
Clinical Social Worker 1041C0700X SW16965 FL Primary

Addresses

Primary practice location

4700 N Habana Ave Ste 703
Tampa, FL 33614-7122

Mailing address

9481 Dowden Rd
Apt 5102
Orlando, FL 32832
Phone (850) 450-3146

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210408001607 FL Practitioner - Clinical Social Worker 3779991864 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2101 Park Ctr Dr
Suite 270
Orlando, FL 32835-7608
Phone (407) 523-1213

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16965FLMDClinical Social Worker
SW16965FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Behavioral Care of North Carolina, PC CurrentSince Feb 15, 2025 Accepting new patients
Cotler Healthcare & Development Inc. CurrentSince Dec 30, 2022 Accepting new patients
MCR Health, Inc. CurrentSince May 22, 2021 Accepting new patients
MCR Health, Inc. CurrentSince May 22, 2021 Accepting new patients
Optum Behavioral Care of North Carolina, P.C. Clinical CurrentSince Feb 15, 2025 Accepting new patients

Locations

306 W Brock Ave
Bonifay, FL 32425
Phone (850) 547-4440

901 S 62nd Ave
Hollywood, FL 33023
Phone (954) 893-0109

9835 Lake Worth Rd
Ste 16179
Lake Worth, FL 33467

2101 Park Center Dr
Ste 270
Orlando, FL 32835
Phone (407) 523-1213

12271 US Highway 301 N
Parrish, FL 34219
Phone (941) 713-2231

1090 Tamiami Trl
Sarasota, FL 34236
Phone 94136308782005

4700 N Habana Ave
Ste 703
Tampa, FL 33614
Phone (813) 678-2373

2225 Knox McRae Dr
Titusville, FL 32780
Phone (321) 267-0060

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1611705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790035200000",
    "number": "1922699602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9481 DOWDEN RD",
            "address_2": "APT 5102",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32832",
            "telephone_number": "850-450-3146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 N HABANA AVE STE 703",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336147122",
            "telephone_number": "941-499-0463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "CAROLYN",
        "middle_name": "MERCEDES",
        "name_prefix": "Ms.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-27",
        "last_updated": "2026-09-22",
        "certification_date": "2026-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "16965",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW16965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.