Healthcare Provider Details

I. General information

NPI: 1396160123
Provider Name (Legal Business Name): JULIE MOYER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 MANTUA GROVE RD BLDG 4
WEST DEPTFORD NJ
08066-1738
US

IV. Provider business mailing address

286 MANTUA GROVE RD BLDG 4
WEST DEPTFORD NJ
08066-1738
US

V. Phone/Fax

Practice location:
  • Phone: 856-599-6204
  • Fax: 856-599-6401
Mailing address:
  • Phone: 856-599-6204
  • Fax: 856-599-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05511000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: