Provider Demographics
NPI:1528021334
Name:MOYER, CHARLENE
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:
Last Name:MOYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 LODER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WAVERLY
Mailing Address - State:PA
Mailing Address - Zip Code:18840-2611
Mailing Address - Country:US
Mailing Address - Phone:570-882-7414
Mailing Address - Fax:570-888-1204
Practice Address - Street 1:356 LODER ST
Practice Address - Street 2:
Practice Address - City:SOUTH WAVERLY
Practice Address - State:PA
Practice Address - Zip Code:18840-2611
Practice Address - Country:US
Practice Address - Phone:570-882-7414
Practice Address - Fax:570-888-1204
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW0122161104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker