Provider Demographics
NPI:1609926237
Name:MORENO, CARIDAD R (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARIDAD
Middle Name:R
Last Name:MORENO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MALAPARDIS RD STE 207
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-1121
Mailing Address - Country:US
Mailing Address - Phone:973-539-9500
Mailing Address - Fax:
Practice Address - Street 1:210 MALAPARDIS RD STE 207
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1121
Practice Address - Country:US
Practice Address - Phone:973-539-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00336800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7184409Medicaid