Provider Demographics
NPI:1205370541
Name:MORENO, KRISTEN (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:LOBSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:2 CROCKER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2528
Mailing Address - Country:US
Mailing Address - Phone:586-468-2266
Mailing Address - Fax:
Practice Address - Street 1:2 CROCKER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2528
Practice Address - Country:US
Practice Address - Phone:586-468-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010983881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical