Provider Demographics
NPI:1952496184
Name:MOORE, JANICE M (PHD, LCSW, BCD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD, LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 S PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-6529
Mailing Address - Country:US
Mailing Address - Phone:610-891-0765
Mailing Address - Fax:610-566-2360
Practice Address - Street 1:332 S PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:PA
Practice Address - Zip Code:19086-6529
Practice Address - Country:US
Practice Address - Phone:610-566-4022
Practice Address - Fax:610-566-2360
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0129211041C0700X
NJ44SC005955001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA045537Medicare ID - Type UnspecifiedMEDICARE
NJ045152Medicare ID - Type UnspecifiedMEDICARE