Provider Demographics
NPI:1083773626
Name:MOYNEHAN, JOHN D (LMFT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:MOYNEHAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 ALMY ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1809
Mailing Address - Country:US
Mailing Address - Phone:401-789-1367
Mailing Address - Fax:
Practice Address - Street 1:1157 SOUTH RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-7633
Practice Address - Country:US
Practice Address - Phone:401-789-1367
Practice Address - Fax:401-783-2558
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMFT00108106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1020890OtherNEIGHBORHOOD HEALTH PLAN
RI32219OtherBLUE CROSS BLUE SHIELD OF RI