Provider Demographics
NPI:1659183614
Name:MOORE, THOMAS GLENN JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GLENN
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1400 NE WALDO RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641-4689
Mailing Address - Country:US
Mailing Address - Phone:352-415-8330
Mailing Address - Fax:
Practice Address - Street 1:20518 NW COUNTY ROAD 2054
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-5968
Practice Address - Country:US
Practice Address - Phone:912-492-8887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW237931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical