Provider Demographics
NPI:1841583077
Name:MORENO, GERALDINE (MFTI)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:MS
Other - First Name:GERALDINE
Other - Middle Name:
Other - Last Name:MORENO JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFTI
Mailing Address - Street 1:45175 PANORAMA DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4482
Mailing Address - Country:US
Mailing Address - Phone:760-346-4665
Mailing Address - Fax:
Practice Address - Street 1:72710 E LYNN ST
Practice Address - Street 2:
Practice Address - City:THOUSAND PALMS
Practice Address - State:CA
Practice Address - Zip Code:92276-3312
Practice Address - Country:US
Practice Address - Phone:760-343-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64673106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist