Healthcare Provider Details

I. General information

NPI: 1023440369
Provider Name (Legal Business Name): JULEY ANNE MOBERG M.S. L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6122 RIDGE AVE
PHILADELPHIA PA
19128
US

IV. Provider business mailing address

635 BOBBIN MILL RD
MEDIA PA
19063
US

V. Phone/Fax

Practice location:
  • Phone: 215-487-1330
  • Fax: 215-487-1641
Mailing address:
  • Phone: 610-566-0776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC006241
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: