Provider Demographics
NPI:1164508081
Name:MORENO, ANN MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 JUDITH ANN CT
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-1411
Mailing Address - Country:US
Mailing Address - Phone:201-529-2202
Mailing Address - Fax:
Practice Address - Street 1:317 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1519
Practice Address - Country:US
Practice Address - Phone:201-445-0717
Practice Address - Fax:201-447-1240
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ058751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical