Provider Demographics
NPI:1033146626
Name:MORIARTY, DEIRDRE MORGAN (PH D)
Entity Type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:MORGAN
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 TINA ST
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565-6904
Mailing Address - Country:US
Mailing Address - Phone:510-501-3151
Mailing Address - Fax:925-887-6467
Practice Address - Street 1:2001 SALVIO ST # 28
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2495
Practice Address - Country:US
Practice Address - Phone:510-501-3151
Practice Address - Fax:925-887-6467
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2019-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11508103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL115080Medicare ID - Type Unspecified