Individual
CAROL MOOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
301 KENT RD, BALA CYNWYD, PA 19004-2823
(610) 667-1540
Mailing address
301 KENT RD, BALA CYNWYD, PA 19004-2823
(610) 667-1540
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS002604L
PA
103T00000X
Psychologist
PS002694L
PA
103TC0700X
Clinical Psychologist
PS002604L
PA
103TC1900X
Counseling Psychologist
PS002604L
PA
Other
Enumeration date
07/24/2020
Last updated
07/24/2020
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