Healthcare Provider Details

I. General information

NPI: 1033774609
Provider Name (Legal Business Name): ELIZABETH EDER-MOREAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 LEXINGTON AVE FRNT 2
NEW YORK NY
10028-2136
US

IV. Provider business mailing address

4 BEATRICE DR
BRYN MAWR PA
19010-2302
US

V. Phone/Fax

Practice location:
  • Phone: 267-301-9848
  • Fax:
Mailing address:
  • Phone: 267-301-9848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number026922
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS020452
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: