Provider Demographics
NPI:1285956490
Name:MORAN, MICHAEL GERALD (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GERALD
Last Name:MORAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 WAYNE ST
Mailing Address - Street 2:#108
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3490
Mailing Address - Country:US
Mailing Address - Phone:646-298-5227
Mailing Address - Fax:
Practice Address - Street 1:281 PAVONIA AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-1605
Practice Address - Country:US
Practice Address - Phone:646-298-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054122001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical