Provider Demographics
NPI:1508651654
Name:MORIARTY, KAYLY RAE (APCC)
Entity type:Individual
Prefix:
First Name:KAYLY
Middle Name:RAE
Last Name:MORIARTY
Suffix:
Gender:
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 TURQUOISE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1298
Mailing Address - Country:US
Mailing Address - Phone:831-421-1058
Mailing Address - Fax:
Practice Address - Street 1:919 TURQUOISE ST APT 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-1298
Practice Address - Country:US
Practice Address - Phone:831-421-1058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC18347101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health