Provider Demographics
NPI:1285963348
Name:MOORE, REBECCA ALICE (MED)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ALICE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 1/2 N MALIN RD
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-1535
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:85 OLD EAGLE SCHOOL RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STRAFFORD
Practice Address - State:PA
Practice Address - Zip Code:19087-2556
Practice Address - Country:US
Practice Address - Phone:610-688-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health