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General NPI Number Information
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NPI Number | 1558405191
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Entity Type | Individual
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Provider Name | STACEY MOYER LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 396 S CENTRE ST 3RD FLOOR
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City | POTTSVILLE
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State | PA
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Zip | 17901-3596
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Country | US
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Telephone | 570-594-6838
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Fax |
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Provider Business Mailing Address
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Address Line | 402 STONEY RUN RD
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City | POTTSVILLE
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State | PA
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Zip | 17901-9115
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Country | US
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Telephone | 570-594-6838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW013434
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License Number State | PA
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