Healthcare Provider Details

I. General information

NPI: 1043709405
Provider Name (Legal Business Name): SARAH ELIZABETH MOYNIHAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 RIVER ST
WELLESLEY MA
02481-2098
US

IV. Provider business mailing address

46 CHARLOTTE AVE
NORTON MA
02766-3025
US

V. Phone/Fax

Practice location:
  • Phone: 781-431-1177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128663
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: