Provider Demographics
NPI:1750097341
Name:MORAN, CARLY CATHERINE (MHC-LP)
Entity type:Individual
Prefix:MISS
First Name:CARLY
Middle Name:CATHERINE
Last Name:MORAN
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 VICHY DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-9030
Mailing Address - Country:US
Mailing Address - Phone:518-290-4803
Mailing Address - Fax:
Practice Address - Street 1:2452 U.S. ROUTE 9
Practice Address - Street 2:SUITE 206
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020
Practice Address - Country:US
Practice Address - Phone:518-292-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP118604101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health