Provider Demographics
NPI:1679503056
Name:MORENO JR., ESPIRIDION (LMSW)
Entity Type:Individual
Prefix:MR
First Name:ESPIRIDION
Middle Name:
Last Name:MORENO JR.
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:TX
Mailing Address - Zip Code:76706-5579
Mailing Address - Country:US
Mailing Address - Phone:254-752-6581
Mailing Address - Fax:254-297-5346
Practice Address - Street 1:WACO VA MEDICAL CENTER
Practice Address - Street 2:4800 MEMORIAL DR.
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711
Practice Address - Country:US
Practice Address - Phone:254-752-6581
Practice Address - Fax:254-297-5346
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03589104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker