Individual provider Active NPI

Jennifer Moore, PSYD

  • Clinical Psychologist
  • Willow Grove, PA
National Provider Identifier
1821648759
Registry record updated Sep 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS018890 Issued in PA
Practice address
2300 Computer Rd Ste C15
Willow Grove, PA 19090-1735
Phone
(484) 440-9740
NPI assigned
Sep 12, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PS018890 PA Primary

Addresses

Primary practice location

2300 Computer Rd Ste C15
Willow Grove, PA 19090-1735

Mailing address

2300 Computer Rd Ste C15
Willow Grove, PA 19090-1735
Phone (484) 440-9740

Other practice location 1

600 N Jackson St Ste 306
Media, PA 19063-2530
Phone (484) 440-9740 ext. 712

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PS018890PAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Dragonfly Psychological Associates Clinical PastSince Sep 15, 2019 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568246400000",
    "number": "1821648759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 COMPUTER RD STE C15",
            "city": "WILLOW GROVE",
            "state": "PA",
            "postal_code": "190901735",
            "telephone_number": "484-440-9740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 COMPUTER RD STE C15",
            "city": "WILLOW GROVE",
            "state": "PA",
            "postal_code": "190901735",
            "telephone_number": "484-440-9740"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 N Jackson St Ste 306",
            "address_purpose": "LOCATION",
            "city": "Media",
            "state": "PA",
            "postal_code": "190632530",
            "country_code": "US",
            "telephone_number": "484-440-9740 x712",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-12",
        "last_updated": "2019-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS018890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willow Grove, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.