Healthcare Provider Details

I. General information

NPI: 1871465880
Provider Name (Legal Business Name): KAYLEE MOYER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 S CENTRE ST STE 3
POTTSVILLE PA
17901-3597
US

IV. Provider business mailing address

396 S CENTRE ST STE 3
POTTSVILLE PA
17901-3597
US

V. Phone/Fax

Practice location:
  • Phone: 570-590-1827
  • Fax: 570-516-9344
Mailing address:
  • Phone: 570-590-1827
  • Fax: 570-516-9344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW026450
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: