Provider Demographics
NPI:1487269577
Name:MORIARTY, PAIGE M
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:M
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PACELLA PARK DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-1755
Mailing Address - Country:US
Mailing Address - Phone:781-437-1215
Mailing Address - Fax:
Practice Address - Street 1:1111 ELM ST STE 7
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1589
Practice Address - Country:US
Practice Address - Phone:413-734-0300
Practice Address - Fax:413-734-0800
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MALABA10000177103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026265EMedicaid