Individual
SUN MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
3300 HENRY AVE, THREE FALL CENTER, SUITE 302, PHILADELPHIA, PA 19129-1121
(215) 924-0684
(215) 924-3805
Mailing address
3300 HENRY AVE, THREE FALL CENTER, SUITE 302, PHILADELPHIA, PA 19129-1121
(215) 924-0684
(215) 924-3805
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
PS015809
PA
103TC0700X
Clinical Psychologist
PS015809
PA
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PS015809
PA
103TM1800X
Intellectual & Developmental Disabilities Psychologist
PS015809
PA
Other
Enumeration date
02/02/2017
Last updated
02/02/2017
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