Provider Demographics
NPI:1952935504
Name:MARCOS MORENO PLLC
Entity Type:Organization
Organization Name:MARCOS MORENO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LCSW
Authorized Official - Prefix:
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:208-391-4841
Mailing Address - Street 1:5154 N BUCKBOARD PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1871
Mailing Address - Country:US
Mailing Address - Phone:208-995-3664
Mailing Address - Fax:
Practice Address - Street 1:2596 N STOKESBERRY PL STE 180
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6282
Practice Address - Country:US
Practice Address - Phone:208-391-4841
Practice Address - Fax:208-391-4966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-22
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty