Provider Demographics
NPI:1659688950
Name:MORIARTY, PHILOMENA (LCSW)
Entity Type:Individual
Prefix:
First Name:PHILOMENA
Middle Name:
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MARIAN CT.
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12009-6215
Mailing Address - Country:US
Mailing Address - Phone:518-788-7007
Mailing Address - Fax:
Practice Address - Street 1:1 MARIAN CT
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:NY
Practice Address - Zip Code:12009-6215
Practice Address - Country:US
Practice Address - Phone:518-788-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032110-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical