Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nydra Moore, LCSW

Individual provider Clinical Social Worker · NPI 1174259287

Nydra Moore, LCSW is a Clinical Social Worker in Grand Rapids, Michigan. Qualified in 2022, 4 years ago. Works from 2 locations. Licensed in Michigan.

Years since qualifying
4
Licensed in
MI
In the registry since
2022
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

790 Fuller Ave NE
Grand Rapids, MI 49503-1918
Phone: (616) 336-3909
Fax: (616) 336-8830
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

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

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 6801120788 (MI)

Record details

NPI number1174259287
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW
Sole proprietorNo
NPI enumeratedJuly 29, 2022
Last updated in NPPESJune 26, 2026
Certification dateJune 26, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Accepts Medicare assignment Not indicated

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