Provider Demographics
NPI:1386922532
Name:MOYNIHAN, THOMAS P SR (LMSW)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:P
Last Name:MOYNIHAN
Suffix:SR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3914
Mailing Address - Country:US
Mailing Address - Phone:516-238-6370
Mailing Address - Fax:516-354-0860
Practice Address - Street 1:58 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3914
Practice Address - Country:US
Practice Address - Phone:516-238-6370
Practice Address - Fax:516-354-0860
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0839951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical