Provider Demographics
NPI:1790979235
Name:MORENO, JESSICA M (MS IMF)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:M
Last Name:MORENO
Suffix:
Gender:F
Credentials:MS IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 ZINFANDEL CT
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-7277
Mailing Address - Country:US
Mailing Address - Phone:916-899-1965
Mailing Address - Fax:
Practice Address - Street 1:1305 ZINFANDEL CT
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-7277
Practice Address - Country:US
Practice Address - Phone:916-899-1965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT102183106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist