Provider Demographics
NPI:1447401856
Name:MOONEY, ERIN GRACE (LICSW)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:GRACE
Last Name:MOONEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 SOUTH UNION STREET
Mailing Address - Street 2:SUITE 207A
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840
Mailing Address - Country:US
Mailing Address - Phone:978-681-9652
Mailing Address - Fax:978-681-9654
Practice Address - Street 1:439 SOUTH UNION STREET
Practice Address - Street 2:SUITE 207A
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840
Practice Address - Country:US
Practice Address - Phone:978-681-9652
Practice Address - Fax:978-681-9654
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA116059104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1154302586Medicaid
MA1154302586Medicaid