Active NPI
Sun Moon, PSY.D.
- Clinical Child & Adolescent Psychologist
- Philadelphia, PA
National Provider Identifier
1982142675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- PS015809
- Practice address
- 3300 Henry Ave
Three Fall Center, Suite 302
Philadelphia, PA 19129-1121 - Phone
- (215) 924-0684
- Fax
- (215) 924-3805
- NPI assigned
- Feb 2, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | PS015809 | PA | |
| Clinical Psychologist | 103TC0700X | PS015809 | PA | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | PS015809 | PA | Primary |
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | PS015809 | PA |
Addresses
Primary practice location
3300 Henry Ave
Three Fall Center, Suite 302
Philadelphia, PA 19129-1121
Mailing address
3300 Henry Ave
Three Fall Center, Suite 302
Philadelphia, PA 19129-1121
Phone (215) 924-0684
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
| License | State | Type | Specialty |
|---|---|---|---|
| PS015809 | PA | MD | Clinical Child & Adolescent Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Progressions Companies, Inc. | Past | 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.
-
- Clinic/Center
- Philadelphia, PA
- NPI 1598807273
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485993600000",
"number": "1982142675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3300 HENRY AVE",
"address_2": "THREE FALL CENTER, SUITE 302",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191291121",
"telephone_number": "215-924-0684",
"fax_number": "215-924-3805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3300 HENRY AVE",
"address_2": "THREE FALL CENTER, SUITE 302",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191291121",
"telephone_number": "215-924-0684",
"fax_number": "215-924-3805"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "SUN",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-02-02",
"last_updated": "2017-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "PA",
"license": "PS015809",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS015809",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "PA",
"license": "PS015809",
"primary": true
},
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "PA",
"license": "PS015809",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.