Healthcare Provider Details

I. General information

NPI: 1821570243
Provider Name (Legal Business Name): BRIAN MORAN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2018
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 N BETHLEHEM PIKE STE 60, #219
SPRING HOUSE PA
19477-1102
US

IV. Provider business mailing address

1121 N BETHLEHEM PIKE STE 60, #219
SPRING HOUSE PA
19477-1102
US

V. Phone/Fax

Practice location:
  • Phone: 215-532-5024
  • Fax:
Mailing address:
  • Phone: 215-532-5024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS018594
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: