Healthcare Provider Details

I. General information

NPI: 1871066936
Provider Name (Legal Business Name): MELINDA J MOYER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 COWPATH RD
SOUDERTON PA
18964-2036
US

IV. Provider business mailing address

1214 DIAMOND ST
SELLERSVILLE PA
18960-2904
US

V. Phone/Fax

Practice location:
  • Phone: 267-203-1500
  • Fax:
Mailing address:
  • Phone: 267-218-2514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number134028
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: