Healthcare Provider Details

I. General information

NPI: 1003546391
Provider Name (Legal Business Name): JOHN GABRIEL MORENO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL STATION GUANTANAMO BAY PSC 1005 BOX 110185
FPO AA
34009
US

IV. Provider business mailing address

NAVAL STATION GUANTANAMO BAY PSC 1005 BOX 110185
FPO AA
34009
US

V. Phone/Fax

Practice location:
  • Phone: 817-689-0245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60732
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: