Provider Demographics
NPI:1407077977
Name:MORIARTY, KATHERINE H (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:H
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 FRIENDSHIP ST
Mailing Address - Street 2:SUITE G-20
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2200
Mailing Address - Country:US
Mailing Address - Phone:401-845-4342
Mailing Address - Fax:401-845-4359
Practice Address - Street 1:19 FRIENDSHIP ST
Practice Address - Street 2:SUITE G-20
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2200
Practice Address - Country:US
Practice Address - Phone:401-845-4342
Practice Address - Fax:401-845-4359
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1140781041C0700X
RIISW018661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical