Healthcare Provider Details

I. General information

NPI: 1386922532
Provider Name (Legal Business Name): THOMAS P MOYNIHAN SR. LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 JEFFERSON ST
GARDEN CITY NY
11530-3914
US

IV. Provider business mailing address

58 JEFFERSON ST
GARDEN CITY NY
11530-3914
US

V. Phone/Fax

Practice location:
  • Phone: 516-238-6370
  • Fax: 516-354-0860
Mailing address:
  • Phone: 516-238-6370
  • Fax: 516-354-0860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number083995
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: