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General NPI Number Information
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NPI Number | 1982142675
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Entity Type | Individual
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Provider Name | SUN MOON PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 02/02/2017
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 3300 HENRY AVE THREE FALL CENTER, SUITE 302
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1121
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Country | US
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Telephone | 215-924-0684
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Fax | 215-924-3805
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Provider Business Mailing Address
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Address Line | 3300 HENRY AVE THREE FALL CENTER, SUITE 302
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1121
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Country | US
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Telephone | 215-924-0684
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Fax | 215-924-3805
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | PS015809
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS015809
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PS015809
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | PS015809
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License Number State | PA
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