Healthcare Provider Details

I. General information

NPI: 1770494585
Provider Name (Legal Business Name): SARAH ELIZABETH MORENO LMSW, SSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 PEBBLEBROOK LN
EAST LANSING MI
48823-2159
US

IV. Provider business mailing address

6160 TOWAR AVE
EAST LANSING MI
48823-1554
US

V. Phone/Fax

Practice location:
  • Phone: 517-333-7900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number68001093367
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number68010093367
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: