Healthcare Provider Details

I. General information

NPI: 1326712431
Provider Name (Legal Business Name): JENNIFER MOORE, LCSW COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 FIELD ST
KANE PA
16735-1322
US

IV. Provider business mailing address

9 FIELD ST
KANE PA
16735-1322
US

V. Phone/Fax

Practice location:
  • Phone: 814-561-1028
  • Fax:
Mailing address:
  • Phone: 814-558-5635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JENNIFER LYNN MOORE
Title or Position: OWNER/ LCSW
Credential: LCSW
Phone: 814-561-1028