Provider Demographics
NPI:1811907090
Name:MORAN, DENNIS MARK (LPC, CAC)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:MARK
Last Name:MORAN
Suffix:
Gender:M
Credentials:LPC, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N CRAIG ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1565
Mailing Address - Country:US
Mailing Address - Phone:412-621-3777
Mailing Address - Fax:412-622-7595
Practice Address - Street 1:1370 WASHINGTON PIKE
Practice Address - Street 2:SUITE 303
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-2862
Practice Address - Country:US
Practice Address - Phone:412-206-0123
Practice Address - Fax:412-206-0128
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1437430OtherBC/BS