Provider Demographics
NPI:1194023895
Name:MORONEY, MIRIAM A (LMHC)
Entity type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:A
Last Name:MORONEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1354 HANCOCK ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5109
Mailing Address - Country:US
Mailing Address - Phone:617-471-5686
Mailing Address - Fax:617-471-6622
Practice Address - Street 1:1354 HANCOCK ST
Practice Address - Street 2:SUITE 209
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5109
Practice Address - Country:US
Practice Address - Phone:617-471-5686
Practice Address - Fax:617-471-6622
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health