Healthcare Provider Details

I. General information

NPI: 1497400956
Provider Name (Legal Business Name): MARIA LUISA MORENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4847 WILLIAMS DR STE 109
GEORGETOWN TX
78633-2420
US

IV. Provider business mailing address

4847 WILLIAMS DR STE 109
GEORGETOWN TX
78633-2420
US

V. Phone/Fax

Practice location:
  • Phone: 737-284-3600
  • Fax: 469-887-6715
Mailing address:
  • Phone: 737-284-3600
  • Fax: 469-887-6715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number66715
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: