Provider Demographics
NPI:1689797425
Name:MORENO, MARIA MORENO (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:MORENO
Last Name:MORENO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 WEST HARRIET STREET
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-4662
Mailing Address - Country:US
Mailing Address - Phone:310-632-0303
Mailing Address - Fax:310-639-2734
Practice Address - Street 1:397 W HARRIET ST
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-4662
Practice Address - Country:US
Practice Address - Phone:310-632-0303
Practice Address - Fax:310-639-2734
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS161491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical