Provider Demographics
NPI:1598222556
Name:MORIARTY, CASSONDRA (IBCLC, FAE)
Entity Type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:IBCLC, FAE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MORSE AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2219
Mailing Address - Country:US
Mailing Address - Phone:803-606-2121
Mailing Address - Fax:
Practice Address - Street 1:37 MORSE AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2219
Practice Address - Country:US
Practice Address - Phone:803-606-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-301551174N00000X
NY374J00000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator