Provider Demographics
NPI:1265921746
Name:MOYNIHAN, JENNIFER TOUSLEY (LCSW, LADC-I, CADC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:TOUSLEY
Last Name:MOYNIHAN
Suffix:
Gender:F
Credentials:LCSW, LADC-I, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR STE 428J
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6122
Mailing Address - Country:US
Mailing Address - Phone:978-529-2740
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 428J
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6122
Practice Address - Country:US
Practice Address - Phone:617-584-5779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20507101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty