Provider Demographics
NPI:1114700465
Name:MOORE, DARYN (CAADC)
Entity Type:Individual
Prefix:
First Name:DARYN
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 ESSEX RD
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19074-1306
Mailing Address - Country:US
Mailing Address - Phone:215-910-9404
Mailing Address - Fax:
Practice Address - Street 1:5901 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3117
Practice Address - Country:US
Practice Address - Phone:215-386-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PA16110101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health