Provider Demographics
NPI:1861814287
Name:MOLONEY, KAREN (CASAC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MOLONEY
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CEDAR GROVE TER
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-1731
Mailing Address - Country:US
Mailing Address - Phone:631-345-5721
Mailing Address - Fax:631-345-5721
Practice Address - Street 1:11 CEDAR GROVE TER
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-1731
Practice Address - Country:US
Practice Address - Phone:631-345-5721
Practice Address - Fax:631-345-5721
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5150101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)