MEDICARE: SHEILA RENE MORENO

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
2	171M00000X	Case Manager/Care Coordinator
3	175T00000X	Peer Specialist
4	1041C0700X	Clinical Social Worker	109900	CA

General Provider Information

NPI Number	:	1568026540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA RENE MORENO

Provider Business Mailing Address
First Line	:	1803 W MARCH LN STE C&D
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-6458
Country	:	US
Telephone Number	:	209-636-5353
Fax Number	:	209-636-5354

Provider Business Practice Location Address
First Line	:	1803 W MARCH LN STE AC&D
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-6458
Country	:	US
Telephone Number	:	209-636-5353
Fax Number	:	209-636-5354

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

Provider Enumeration Date	:	04/25/2019
Last Update Date	:	08/16/2023

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