Provider Demographics
NPI:1528036233
Name:MOORE, ROBERT JOHN (LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 COMMERCE DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2402
Mailing Address - Country:US
Mailing Address - Phone:215-540-5860
Mailing Address - Fax:215-540-5864
Practice Address - Street 1:220 COMMERCE DR
Practice Address - Street 2:SUITE 401
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2402
Practice Address - Country:US
Practice Address - Phone:215-540-5860
Practice Address - Fax:215-540-5864
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002233101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor