Provider Demographics
NPI:1467672402
Name:MORENO, TRACI LEANE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:LEANE
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 1:7272 WURZBACH RD
Mailing Address - Street 2:#601
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240
Mailing Address - Country:US
Mailing Address - Phone:210-615-3408
Mailing Address - Fax:877-788-3229
Practice Address - Street 1:3050 SUNNYBROOK RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405
Practice Address - Country:US
Practice Address - Phone:888-365-6271
Practice Address - Fax:210-615-1877
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker