Provider Demographics
NPI:1235537473
Name:HENDRICKSMORENO, DESIRE (MS LSW)
Entity Type:Individual
Prefix:
First Name:DESIRE
Middle Name:
Last Name:HENDRICKSMORENO
Suffix:
Gender:F
Credentials:MS LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 MEETINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-2617
Mailing Address - Country:US
Mailing Address - Phone:508-679-0033
Mailing Address - Fax:508-679-0037
Practice Address - Street 1:279 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:508-679-0033
Practice Address - Fax:508-679-0037
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)