Provider Demographics
NPI:1013501634
Name:MORENO IZAGUIRRE, RAQUEL (PLMHP, PCMSW)
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:
Last Name:MORENO IZAGUIRRE
Suffix:
Gender:F
Credentials:PLMHP, PCMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-1121
Mailing Address - Country:US
Mailing Address - Phone:402-309-9978
Mailing Address - Fax:
Practice Address - Street 1:2201 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1121
Practice Address - Country:US
Practice Address - Phone:402-309-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12463101YM0800X
NE75671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health