Individual
JARED MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
4701 PINE ST, APT. B13, PHILADELPHIA, PA 19143-1816
(201) 310-6508
Mailing address
4742 PINE ST, APT 402, PHILADELPHIA, PA 19143-1968
(201) 310-6508
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS017735
PA
Other
Enumeration date
12/20/2014
Last updated
06/20/2018
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