MEDICARE: JENNIFER MORENO LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	180013025
2	101YM0800X	Mental Health Counselor	M65043384798	IL
3	101Y00000X	Counselor

General Provider Information

NPI Number	:	1144559014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MORENO LCPC

Provider Business Mailing Address
First Line	:	1511 WESTMINSTER DR
Second Line	:	UNIT 102
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-9216
Country	:	US
Telephone Number	:	331-472-4568
Fax Number	:

Provider Business Practice Location Address
First Line	:	1511 WESTMINSTER DR
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-9216
Country	:	US
Telephone Number	:	331-472-4568
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2009
Last Update Date	:	07/26/2021

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