Provider Demographics
NPI:1154989853
Name:MOYNIHAN, LAURA LYNN (LICSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:MOYNIHAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 RUSTIC DR
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-2615
Mailing Address - Country:US
Mailing Address - Phone:401-578-1140
Mailing Address - Fax:
Practice Address - Street 1:RHODE ISLAND HOSPITAL
Practice Address - Street 2:593 EDDY ST
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-444-5076
Practice Address - Fax:401-444-7887
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW028181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical