Provider Demographics
NPI:1083058978
Name:MOYNIHAN, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:MOYNIHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-2309
Mailing Address - Country:US
Mailing Address - Phone:978-380-8135
Mailing Address - Fax:
Practice Address - Street 1:66 COUNTY RD
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-2309
Practice Address - Country:US
Practice Address - Phone:978-380-8135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA04-2104791OtherCLINICIAN