Provider Demographics
NPI:1912065178
Name:MORENO, CARLOS G (MSW CLIN THER SOC WK)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:G
Last Name:MORENO
Suffix:
Gender:M
Credentials:MSW CLIN THER SOC WK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3583 CARLISLE ST
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-7303
Mailing Address - Country:US
Mailing Address - Phone:951-943-6187
Mailing Address - Fax:951-358-3548
Practice Address - Street 1:9990 COUNTY FARM RD
Practice Address - Street 2:SUITE 5
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3542
Practice Address - Country:US
Practice Address - Phone:951-358-3082
Practice Address - Fax:951-635-8354
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS236471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical