Provider Demographics
NPI:1093380677
Name:MOONEY, CARLY JENNIFER (MFT)
Entity Type:Individual
Prefix:MS
First Name:CARLY
Middle Name:JENNIFER
Last Name:MOONEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:CJ
Other - Middle Name:
Other - Last Name:MOONEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:1926 ELLSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2913
Mailing Address - Country:US
Mailing Address - Phone:609-330-7923
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST STE 2200
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6221
Practice Address - Country:US
Practice Address - Phone:267-713-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist