Provider Demographics
NPI:1508316282
Name:MORENO, STEFANIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STEFANIE
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 1:914 RHONDA PL SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-5634
Mailing Address - Country:US
Mailing Address - Phone:301-788-7100
Mailing Address - Fax:
Practice Address - Street 1:914 RHONDA PL SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175
Practice Address - Country:US
Practice Address - Phone:301-788-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD115891041C0700X
VA09040092611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA13833970OtherCAQH