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NPI Code Detail

MEDICARE: ANITA MORENO LISW

MEDICARE: ANITA MORENO LISW
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
11041C0700XClinical Social WorkerI7599OH
21041C0700XClinical Social WorkerSW16286FL

General Provider Information

NPI Number : 1649309006
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANITA MORENO LISW
Provider Business Mailing Address
First Line : 12724 GRAN BAY PKWY W STE 410
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32258-9486
Country : US
Telephone Number : 904-337-9003
Fax Number : 904-485-8704
Provider Business Practice Location Address
First Line : 12724 GRAN BAY PKWY W STE 410
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32258-9486
Country : US
Telephone Number : 904-337-9003
Fax Number : 904-485-8704
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2007
Last Update Date : 02/26/2020

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Directions to “ ANITA MORENO LISW” Practice Location

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