Individual
JOHN D MOYNEHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
1157 SOUTH RD, WAKEFIELD, RI 02879-7633
(401) 789-1367
(401) 783-2558
Mailing address
61 ALMY ST, NEWPORT, RI 02840-1809
(401) 789-1367
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFT00108
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1020890
NEIGHBORHOOD HEALTH PLAN
RI
01
—
32219
BLUE CROSS BLUE SHIELD OF RI
RI
Enumeration date
12/08/2006
Last updated
07/15/2008
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