Provider Demographics
NPI:1649546078
Name:MORIARTY, KATHARINE AMY FARRELL (MA)
Entity type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:AMY FARRELL
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUXTON
Mailing Address - State:ME
Mailing Address - Zip Code:04093-6105
Mailing Address - Country:US
Mailing Address - Phone:207-929-3831
Mailing Address - Fax:207-642-7898
Practice Address - Street 1:94 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUXTON
Practice Address - State:ME
Practice Address - Zip Code:04093-6105
Practice Address - Country:US
Practice Address - Phone:207-929-3831
Practice Address - Fax:207-642-7898
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP 2195235Z00000X
MEST2092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist