Provider Demographics
NPI:1093312597
Name:MORENO, MEGAN RACHAEL (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:RACHAEL
Last Name:MORENO
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:RACHAEL
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8495 SANDERS DR
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-9190
Mailing Address - Country:US
Mailing Address - Phone:808-319-9974
Mailing Address - Fax:
Practice Address - Street 1:901 CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1552
Practice Address - Country:US
Practice Address - Phone:810-232-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68030872371041C0700X
MI68511141111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical