Healthcare Provider Details

I. General information

NPI: 1033906284
Provider Name (Legal Business Name): STEVEN MORENO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1115
BASALT CO
81621-1115
US

IV. Provider business mailing address

250 COUNTY ROAD 127 TRLR 14
GLENWOOD SPRINGS CO
81601-9265
US

V. Phone/Fax

Practice location:
  • Phone: 970-989-3490
  • Fax:
Mailing address:
  • Phone: 970-989-3490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW.0009925054
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: