Healthcare Provider Details

I. General information

NPI: 1477071611
Provider Name (Legal Business Name): THERESE ANN MORENO PLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 1ST ST NW
ALBUQUERQUE NM
87102-2355
US

IV. Provider business mailing address

912 1ST ST NW
ALBUQUERQUE NM
87102-2355
US

V. Phone/Fax

Practice location:
  • Phone: 505-224-9777
  • Fax: 505-244-9779
Mailing address:
  • Phone: 505-224-9777
  • Fax: 505-244-9779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX10178
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11743
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: