Provider Demographics
NPI:1639654049
Name:MORIARTY, SHANA (LSCSW)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-4511
Mailing Address - Country:US
Mailing Address - Phone:913-565-0364
Mailing Address - Fax:833-281-1587
Practice Address - Street 1:2300 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-4511
Practice Address - Country:US
Practice Address - Phone:913-565-0364
Practice Address - Fax:833-281-1587
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0055971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical