Provider Demographics
NPI:1952083263
Name:MORENO, ANDEE DAWN (ASW)
Entity Type:Individual
Prefix:
First Name:ANDEE
Middle Name:DAWN
Last Name:MORENO
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:DAWN
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ASW
Mailing Address - Street 1:5721 LAKE MURRAY BLVD APT 15
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1908
Mailing Address - Country:US
Mailing Address - Phone:619-840-3041
Mailing Address - Fax:800-441-0839
Practice Address - Street 1:995 GATEWAY CENTER WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-4500
Practice Address - Country:US
Practice Address - Phone:619-262-1960
Practice Address - Fax:619-262-2420
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116780104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker