Provider Demographics
NPI:1548409766
Name:AHEARNE, MOIRA KATHLEEN (MDIV, MSSW)
Entity Type:Individual
Prefix:MS
First Name:MOIRA
Middle Name:KATHLEEN
Last Name:AHEARNE
Suffix:
Gender:F
Credentials:MDIV, MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 WARD ST
Mailing Address - Street 2:
Mailing Address - City:EAST WILLISTON
Mailing Address - State:NY
Mailing Address - Zip Code:11596-1941
Mailing Address - Country:US
Mailing Address - Phone:516-747-3965
Mailing Address - Fax:
Practice Address - Street 1:132 JEFFERSON AVENUE
Practice Address - Street 2:LUTHERAN COUNSELING CENTER
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-741-0994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR047522-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical