Provider Demographics
NPI:1881822575
Name:MORENO, GLORIA MARINA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:MARINA
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 1:5835 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-4029
Mailing Address - Country:US
Mailing Address - Phone:323-725-4629
Mailing Address - Fax:323-728-9201
Practice Address - Street 1:14609 MARYTON AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-5152
Practice Address - Country:US
Practice Address - Phone:562-404-9790
Practice Address - Fax:562-404-9790
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225101041C0700X
CALCS225101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical