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General NPI Number Information
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NPI Number | 1508985276
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Entity Type | Individual
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Provider Name | JOAN MARIE MORIARTY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 01/20/2019
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Provider Practice Location Address
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Address Line | 55 W MAPLE RD SUITE 210
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City | BIRMINGHAM
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State | MI
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Zip | 48009-3303
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Country | US
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Telephone | 313-562-0550
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Fax |
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Provider Business Mailing Address
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Address Line | 280 W MAPLE RD STE 219
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City | BIRMINGHAM
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State | MI
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Zip | 48009-3349
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Country | US
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Telephone | 313-562-0550
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number | 6301002029
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 6301002029
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | 6301002029
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301002029
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License Number State | MI
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