Healthcare Provider Details

I. General information

NPI: 1023392537
Provider Name (Legal Business Name): FRANCIS X MORIARTY ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 OLD DEPOT RD
ARLINGTON VT
05250-8748
US

IV. Provider business mailing address

PO BOX 824
MANCHESTER CENTER VT
05255-0824
US

V. Phone/Fax

Practice location:
  • Phone: 413-822-3661
  • Fax:
Mailing address:
  • Phone: 802-362-3437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number048.0000526
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: