Provider Demographics
NPI:1598068595
Name:MOORE, PATRICK W
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:W
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 PENN AVENUE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1626
Mailing Address - Country:US
Mailing Address - Phone:412-441-9786
Mailing Address - Fax:412-363-2375
Practice Address - Street 1:5150 PENN AVENUE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1626
Practice Address - Country:US
Practice Address - Phone:412-441-9786
Practice Address - Fax:412-363-2375
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)