Provider Demographics
NPI:1356918809
Name:MOORE, SAMUEL G (LSW)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:G
Last Name:MOORE
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-9002
Mailing Address - Country:US
Mailing Address - Phone:484-869-3228
Mailing Address - Fax:
Practice Address - Street 1:1800 N 12TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19604-1545
Practice Address - Country:US
Practice Address - Phone:610-816-5728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker