Individual
MARY THERESE MOYNIHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
268 STILLWATER AVE, BANGOR, ME 04401-3945
(207) 973-6100
Mailing address
268 STILLWATER AVE, BANGOR, ME 04401-3945
(207) 973-6100
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
MC18123
ME
1041C0700X
Clinical Social Worker
Primary
LC20176
ME
Other
Enumeration date
07/08/2019
Last updated
10/20/2021
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