Lisa Jeanine Moore | Southfield, MI • PECOS Search

Lisa Jeanine Moore

Social Worker

Behavioral Health & Social Service Providers

22511 Telegraph Rd, Suite 101, Southfield, MI 48033-4115

PECOS Enrollment

Based on the most recent information from CMS, provider Lisa Jeanine Moore does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 11:21 AM.

Profile Details

Provider ID
1295962413
Provider Type
Individual
Full Name
Moore, Lisa Jeanine
Title
Mrs.
Credential
LMSW

Gender
Female
Sole Proprietor
Yes
Enumeration Date
6/15/2009
Last Updated
6/15/2009

Contact Information

Practice Location

22511 Telegraph Rd, Suite 101, Southfield, MI 48033-4115

Unlisted Fax

Mailing Location

22511 Telegraph Rd, Suite 101, Southfield, MI 48033-4115

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 6801078772 Michigan