Provider Demographics
NPI:1114712395
Name:MORAN, MATT
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:MORAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 ESTHER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-4734
Mailing Address - Country:US
Mailing Address - Phone:412-443-4445
Mailing Address - Fax:
Practice Address - Street 1:516 ESTHER AVE
Practice Address - Street 2:
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-4734
Practice Address - Country:US
Practice Address - Phone:412-443-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician