Individual
DERIK MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
230 S BROAD ST STE 1903, PHILADELPHIA, PA 19102-4121
(267) 258-1027
Mailing address
451 ROXBOROUGH AVE, PHILADELPHIA, PA 19128-3536
(267) 258-1027
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
44SC05928700
NJ
1041C0700X
Clinical Social Worker
Primary
CW018657
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102852871
—
PA
Enumeration date
08/08/2013
Last updated
09/02/2024
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