Provider Demographics
NPI:1780291369
Name:MORIARTY, BRIDIE KAITLIN (NY)
Entity type:Individual
Prefix:DR
First Name:BRIDIE
Middle Name:KAITLIN
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:NY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SCHENCK AVE APT 2AE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3621
Mailing Address - Country:US
Mailing Address - Phone:203-470-6479
Mailing Address - Fax:
Practice Address - Street 1:1010 NORTHERN BLVD STE 416
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5330
Practice Address - Country:US
Practice Address - Phone:518-487-7116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist