Provider Demographics
NPI:1609224054
Name:MORIARTY, CAROLYN (MA COUNSELING)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:MA COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 N CICERO AVE STE 630
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4392
Mailing Address - Country:US
Mailing Address - Phone:773-932-9597
Mailing Address - Fax:
Practice Address - Street 1:6160 N CICERO AVE STE 630
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4392
Practice Address - Country:US
Practice Address - Phone:773-932-9597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty