Provider Demographics
NPI:1649379389
Name:MORIARTY, GINGER DANE (MSW)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:DANE
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:VIRGINA
Other - Last Name:MORIARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:5238 LYNWOOD CENTER RD NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-4002
Mailing Address - Country:US
Mailing Address - Phone:206-919-5216
Mailing Address - Fax:
Practice Address - Street 1:5238 LYNWOOD CENTER RD NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-4002
Practice Address - Country:US
Practice Address - Phone:206-919-5216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00004048101YM0800X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker