Healthcare Provider Details

I. General information

NPI: 1891940268
Provider Name (Legal Business Name): ELISABETH V MORENO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N GLEBE RD STE 525
ARLINGTON VA
22201-5792
US

IV. Provider business mailing address

1005 N GLEBE RD STE 525
ARLINGTON VA
22201-5792
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax:
Mailing address:
  • Phone: 804-207-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114814
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904016893
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: