Provider Demographics
NPI:1548578115
Name:MORENO-KRONCKE, XIOMARA G (MSW)
Entity Type:Individual
Prefix:MS
First Name:XIOMARA
Middle Name:G
Last Name:MORENO-KRONCKE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-8090
Mailing Address - Country:US
Mailing Address - Phone:415-409-4611
Mailing Address - Fax:415-409-4617
Practice Address - Street 1:684 ELLIS ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-8090
Practice Address - Country:US
Practice Address - Phone:415-409-4611
Practice Address - Fax:415-409-4617
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942507835Medicaid
CA1134421621Medicaid