Provider Demographics
NPI:1619118981
Name:EDWARD G. MORAN, III, LCSW, LLC
Entity Type:Organization
Organization Name:EDWARD G. MORAN, III, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:III
Authorized Official - Credentials:MSW
Authorized Official - Phone:203-253-7706
Mailing Address - Street 1:111 EAST AVE
Mailing Address - Street 2:SUITE 313
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5014
Mailing Address - Country:US
Mailing Address - Phone:203-253-7706
Mailing Address - Fax:203-642-3576
Practice Address - Street 1:111 EAST AVE
Practice Address - Street 2:SUITE 313
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5014
Practice Address - Country:US
Practice Address - Phone:203-253-7706
Practice Address - Fax:203-642-3576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0058501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty