Provider Demographics
NPI:1942599949
Name:MORIARITY, EDWARD PATRICK III (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:PATRICK
Last Name:MORIARITY
Suffix:III
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4222
Mailing Address - Country:US
Mailing Address - Phone:406-546-6597
Mailing Address - Fax:
Practice Address - Street 1:124 W PINE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4222
Practice Address - Country:US
Practice Address - Phone:406-546-6597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical