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General NPI Number Information
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NPI Number | 1679971865
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Entity Type | Individual
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Provider Name | JARED MOORE PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 12/20/2014
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 4701 PINE ST APT. B13
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City | PHILADELPHIA
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State | PA
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Zip | 19143-1816
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Country | US
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Telephone | 201-310-6508
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Fax |
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Provider Business Mailing Address
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Address Line | 4742 PINE ST APT 402
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City | PHILADELPHIA
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State | PA
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Zip | 19143-1968
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Country | US
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Telephone | 201-310-6508
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS017735
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License Number State | PA
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