Most Relevant Information
Provider Data
| NPI Number: | 1003824194 |
| Provider Name: | EDWARD TINDAL MOON PSY D |
| Entity Type: | Individual |
| Taxonomy Code: | 103TC0700X |
| Specialty: | Psychologist |
| License Number: | PS007695L |
Most Important Dates
| Enumeration Date: | 08/04/2006 |
| Last Updated: | 12/06/2016 |
Provider Practice Location
255 S 17TH ST
SUITE 2301
PHILADELPHIA
PA
191036231
Practice Location Phone/Fax
| Phone: | 6106590774 |
| Fax: |
Provider Mailing Location
255 S 17TH ST
SUITE 2301
PHILADELPHIA
PA
191036231
Provider Mailing Phone/Fax
| Phone: | 6106590774 |
| Fax: |