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General NPI Number Information
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NPI Number | 1508416942
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Entity Type | Individual
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Provider Name | SAMMANTHA VIONNIE MORENO LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 301 E 13TH ST STE D
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City | MERCED
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State | CA
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Zip | 95341-6211
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Country | US
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Telephone | 209-381-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 1 W MAIN ST
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City | MERCED
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State | CA
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Zip | 95340-4928
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Country | US
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Telephone | 209-628-7819
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 91812
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 107152
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License Number State | CA
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