Provider Demographics
NPI:1447502646
Name:MOORE, SHEREE RENEE
Entity type:Individual
Prefix:
First Name:SHEREE
Middle Name:RENEE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19051
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-0051
Mailing Address - Country:US
Mailing Address - Phone:510-593-0108
Mailing Address - Fax:341-946-6172
Practice Address - Street 1:3120 HERRIOTT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-2625
Practice Address - Country:US
Practice Address - Phone:510-930-1085
Practice Address - Fax:341-946-6172
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA823161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical