MEDICARE: MISS AYLEENE MORENO M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1548557069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AYLEENE MORENO M.S.

Provider Business Mailing Address
First Line	:	6000 SILVER OAK DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-3226
Country	:	US
Telephone Number	:	772-626-8022
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 SILVER OAK DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-3226
Country	:	US
Telephone Number	:	772-626-8022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2011
Last Update Date	:	07/05/2011

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Directions to “ MISS AYLEENE MORENO M.S.” Practice Location

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