Provider Demographics
NPI:1508160771
Name:MOORE, NEDWARD B;AINE III (BA)
Entity Type:Individual
Prefix:MR
First Name:NEDWARD
Middle Name:B;AINE
Last Name:MOORE
Suffix:III
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 PLANE RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:PA
Mailing Address - Zip Code:15946-6704
Mailing Address - Country:US
Mailing Address - Phone:814-736-9700
Mailing Address - Fax:
Practice Address - Street 1:220 PLANE RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:PA
Practice Address - Zip Code:15946-6704
Practice Address - Country:US
Practice Address - Phone:814-736-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor