Provider Demographics
NPI:1013072792
Name:MOYNIHAN, EUGENE FRANCIS JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:FRANCIS
Last Name:MOYNIHAN
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 S BICYCLE PATH
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-3825
Mailing Address - Country:US
Mailing Address - Phone:631-698-2155
Mailing Address - Fax:631-698-2155
Practice Address - Street 1:131 S BICYCLE PATH
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-3825
Practice Address - Country:US
Practice Address - Phone:631-698-2155
Practice Address - Fax:631-698-2155
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0502941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYND4891Medicare ID - Type Unspecified