Individual provider · Type 1 NPI

Nydra Moore, LCSW

Clinical Social Worker · Grand Rapids, MI

NPI number 1174259287 Active

Practice location

790 Fuller Ave NE
Grand Rapids, MI 49503-1918

Call (616) 336-3909 Map

Fax (616) 336-8830

Other practice locations

  • 620 Century Ave SW Ste 120, Grand Rapids, MI 49503-4977 · (616) 329-9857

Specialties and licenses

TaxonomyCodeLicense
Clinical Social Worker Primary 1041C0700X6801120788 (MI)

Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…

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About NPI 1174259287

Nydra Moore, LCSW's National Provider Identifier is 1174259287, issued on Jul 29, 2022. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Grand Rapids, MI. The record was last updated on Jun 26, 2026.