Provider Demographics
NPI:1598447906
Name:MORIARTY, MARY BERNER
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BERNER
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2691
Mailing Address - Country:US
Mailing Address - Phone:617-522-0650
Mailing Address - Fax:
Practice Address - Street 1:2450 S UNIVERSITY BLVD UNIT 305
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5489
Practice Address - Country:US
Practice Address - Phone:646-539-8364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor