Provider Demographics
NPI:1013332188
Name:MOORE, JEAN GLADYS (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:GLADYS
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8513 MANSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-3207
Mailing Address - Country:US
Mailing Address - Phone:215-275-7134
Mailing Address - Fax:
Practice Address - Street 1:67 BUCK RD STE B22
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1538
Practice Address - Country:US
Practice Address - Phone:215-275-7134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health