Provider Demographics
NPI:1871663666
Name:MORENO, RUBEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RUBEN
Middle Name:
Last Name:MORENO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 GATEWAY BLVD W STE 501
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3319
Mailing Address - Country:US
Mailing Address - Phone:915-772-1829
Mailing Address - Fax:915-772-5133
Practice Address - Street 1:5959 GATEWAY BLVD W STE 501
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3319
Practice Address - Country:US
Practice Address - Phone:915-772-1829
Practice Address - Fax:915-772-5133
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S69WMedicare ID - Type Unspecified