Provider Demographics
NPI:1972170702
Name:MOIMAS, MARJATTA MIRJAMI (MA, BSW)
Entity Type:Individual
Prefix:MRS
First Name:MARJATTA
Middle Name:MIRJAMI
Last Name:MOIMAS
Suffix:
Gender:F
Credentials:MA, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SLIPPER HILL LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:MA
Mailing Address - Zip Code:01522-1408
Mailing Address - Country:US
Mailing Address - Phone:315-734-5446
Mailing Address - Fax:
Practice Address - Street 1:15 SLIPPER HILL LN
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:MA
Practice Address - Zip Code:01522-1408
Practice Address - Country:US
Practice Address - Phone:315-734-5446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)