Provider Demographics
NPI:1568236891
Name:MORENO, MACARENA ISABEL (CSW)
Entity Type:Individual
Prefix:
First Name:MACARENA
Middle Name:ISABEL
Last Name:MORENO
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 E BLACK CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-5462
Mailing Address - Country:US
Mailing Address - Phone:908-358-8362
Mailing Address - Fax:
Practice Address - Street 1:3051 W MAPLE LOOP DR STE 300
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-6552
Practice Address - Country:US
Practice Address - Phone:385-336-4740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13576785-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical