| Doctor Name: | MARA BALDWIN MOORE |
| NPI Number: | 1497837843 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICSW |
| License Number: | 111828 |
| Business Practice Address: | 90 Vandenberg Dr Hanscom Afb, MA - 017312104 |
| Business Phone Number: | 7813775930 |
| Business Fax Number: | 7813774385 |
| Mailing Address: | 24 Dexter Ave, Apt. #2 WATERTOWN |
| State: | MA |
| Postal Code: | 024724107 |
| Phone Number: | 7813775930 |
| Fax Number: | 7813774385 |
| NPI Enumeration Date: | 10/19/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 111828 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |