Provider Demographics
NPI:1033128061
Name:MOORE, KEVIN LEE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:LEE
Last Name:MOORE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 JONATHAN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:13104
Mailing Address - Country:US
Mailing Address - Phone:610-433-8550
Mailing Address - Fax:610-433-4488
Practice Address - Street 1:1728 JONATHAN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:13104
Practice Address - Country:US
Practice Address - Phone:610-433-8550
Practice Address - Fax:610-433-4488
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0126291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical