MEDICARE: GABRIELLE MOONEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	221700000X	Art Therapist	23-097	PA
2	101YP2500X	Professional Counselor	PC018893	PA
3	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1700382173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE MOONEY

Provider Business Mailing Address
First Line	:	7901 BUSTLETON AVE STE 300
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-3330
Country	:	US
Telephone Number	:	215-537-5367
Fax Number	:

Provider Business Practice Location Address
First Line	:	7901 BUSTLETON AVE STE 300
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-3330
Country	:	US
Telephone Number	:	215-537-5367
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	12/05/2025

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1194940502 — SUPPORTIVE BEHAVIORAL RESOURCES, INC.
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1104561646 — RYAN KEOUGH
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7901 BUSTLETON AVE STE 300
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1942036868 — NATALIE NIXSON
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1386510790 — GWYNETH SHUMAR MA, LMFT
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Directions to “ GABRIELLE MOONEY ” Practice Location

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