Provider Demographics
NPI:1932238722
Name:MORENO, SANDRA (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930-1357
Mailing Address - Country:US
Mailing Address - Phone:509-882-4260
Mailing Address - Fax:509-882-6088
Practice Address - Street 1:240 DIVISION ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-1357
Practice Address - Country:US
Practice Address - Phone:509-882-4260
Practice Address - Fax:509-882-6088
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker