Individual
ROBERT JOHN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
1633 FAIRMOUNT AVE, PHILADELPHIA, PA 19130-2352
(215) 828-7764
Mailing address
1633 FAIRMOUNT AVE, PHILADELPHIA, PA 19130-2352
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW1307487
PA
Other
Enumeration date
06/02/2019
Last updated
06/02/2019
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