Provider Demographics
NPI:1578910329
Name:MORENO, ARQUISHA TYESHA
Entity Type:Individual
Prefix:
First Name:ARQUISHA
Middle Name:TYESHA
Last Name:MORENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ARQUISHA
Other - Middle Name:
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LAC
Mailing Address - Street 1:57 UNION ST
Mailing Address - Street 2:APT 32
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-6301
Mailing Address - Country:US
Mailing Address - Phone:401-286-0888
Mailing Address - Fax:
Practice Address - Street 1:57 UNION ST
Practice Address - Street 2:APT 32
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-6301
Practice Address - Country:US
Practice Address - Phone:401-286-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00312200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional