Provider Demographics
NPI:1942364492
Name:MORIARTY, JILL (MA,LCMHC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:MA,LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 514
Mailing Address - Street 2:
Mailing Address - City:CENTER HARBOR
Mailing Address - State:NH
Mailing Address - Zip Code:03226-0514
Mailing Address - Country:US
Mailing Address - Phone:603-455-1708
Mailing Address - Fax:603-253-9917
Practice Address - Street 1:67 WATER ST
Practice Address - Street 2:SUITE #205
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3300
Practice Address - Country:US
Practice Address - Phone:603-455-1708
Practice Address - Fax:603-253-9917
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30426883Medicaid
NH889985AOtherMVP HEALTHCARE
NH7706646Y0NH01OtherANTHEM