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General NPI Number Information
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NPI Number | 1780125583
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Entity Type | Individual
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Provider Name | ELIA MORENO THOMAS ACSW
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Gender | Female
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 1128 YUBA ST
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City | MARYSVILLE
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State | CA
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Zip | 95901-4831
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Country | US
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Telephone | 530-321-4796
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Fax |
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Provider Business Mailing Address
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Address Line | 1128 YUBA ST
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City | MARYSVILLE
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State | CA
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Zip | 95901-4831
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Country | US
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Telephone | 530-321-6479
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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 | 114789
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License Number State | CA
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