Provider Demographics
NPI:1225142979
Name:MORIARTA, MARCIA LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:LYNN
Last Name:MORIARTA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
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Mailing Address - Street 1:1650 UNIVERSITY NE
Mailing Address - Street 2:STE 220
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102
Mailing Address - Country:US
Mailing Address - Phone:505-272-8950
Mailing Address - Fax:505-272-3202
Practice Address - Street 1:2211 LOMAS NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131
Practice Address - Country:US
Practice Address - Phone:505-272-8950
Practice Address - Fax:505-272-3202
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM0842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ106844Medicaid