Provider Demographics
NPI:1154416840
Name:MORIARTY, MARIANNE JULIE (LMHC)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:JULIE
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:JULIE
Other - Last Name:POPKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:30 SOUTHWICK ST AGAWAM COUNSELING CENTER
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030
Mailing Address - Country:US
Mailing Address - Phone:413-786-6410
Mailing Address - Fax:413-789-9623
Practice Address - Street 1:30 SOUTHWICK ST
Practice Address - Street 2:AGAWAM COUNSELING CENTER
Practice Address - City:FEEDING HILLS
Practice Address - State:MA
Practice Address - Zip Code:01030
Practice Address - Country:US
Practice Address - Phone:413-786-6410
Practice Address - Fax:413-789-9623
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5505101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health