Most Relevant Information
Provider Data
| NPI Number: | 1003575002 |
| Provider Name: | ELYZA MOORE LICSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 089.0124729 |
Most Important Dates
| Enumeration Date: | 12/17/2021 |
| Last Updated: | 12/17/2021 |
Provider Practice Location
1138 PINE ST
BURLINGTON
VT
054015353
Practice Location Phone/Fax
| Phone: | 8024886000 |
| Fax: | 8024886919 |
Provider Mailing Location
208 FLYNN AVE STE 3J
BURLINGTON
VT
054015420
Provider Mailing Phone/Fax
| Phone: | 8024886920 |
| Fax: | 8024886919 |